Breast Cancer Celebration
RSVP and Survior Recognition Intake Form
Location: 4568 Covington Highway Decatur, Ga 30035
Date: October 17, 2021
Time: 2p - 7pm
Contact: Katrice Simmons-Brinson 678-281-5443
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Email *
RSVP Full Name
Phone Number and Email
Additional Number of Guest
RSVP Options for Event Seating
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Survivor Recognition and Award Deadline 9-17-2021
Please select the preferred package you want to have presented to your Survivor
Breast Cancer Survivor Award Package
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Survivor Full Name to be Honored
Please briefly describe your survivor 75 words or less to be published. *We will contact you if alterations are required.
To finalize your reservation please select payment option. Selection will not be guranteed until full payment is made. * No Refunds *
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