Pearl of Wisdom

My organization would like to become a:

Partner—We are a national non-profit organization or medical association.

Supporter—We are a business, club, or regional or local non-profit organization, or I am a cervical cancer survivor/advocate.

Do you agree to the following?:

Yes! My organization would like to partner with the Pearl of Wisdom Campaign to Prevent Cervical Cancer.

As a partner, our organization will help promote the campaign and its messages. Also, the campaign may use our organization’s name and logo on its website and in promotional materials.

Organization: *

(* marks a required field)

Organization's Mission:

Organization's URL:

Street Address: *

City: *

State: *

Zip: *

Contact Name: *

Contact Title: *

Contact Email: *

Contact Phone: *

Number of members/affiliates:

How your organization plans to promote the Pearl of Wisdom Campaign’s messages:

Newsletter articles

Press release

Information on website

Distribute materials at conferences

Other:

How did you learn about the Pearl of Wisdom campaign?:

Your name (if different from contact above):

Are you a cervical cancer survivor?:

Yes, I am a cervical cancer survivor

Are you authorized to commit the organization?: *

I am authorized to commit the organization above to be a Partner in the Pearl of Wisdom campaign.

Confirm subscription to our mailing list.:

Become a Partner or Supporter

The benefits to your organization

Your organization’s commitment

Partner/Supporter Registration Form