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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
*
Your email
RSVP Full Name
Your answer
Phone Number and Email
Your answer
Additional Number of Guest
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RSVP Options for Event Seating
$5 Individual Inflatible Chair
$25 4 Person Table
$50 Tent with table seats 5
RSVP Dinner Plate $10 each in advance $15 and up at the door
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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
Bronze: $20 Lovely Warrior includes Dinner and Gift box
Gold: $50 Legacy Warrior includes Dinner, Gift Box, and Award
Platinum: $75 Lifetime Warrior includes Dinner, Gift Box, Award, and name recognition with a book copy
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Survivor Full Name to be Honored
Your answer
Please briefly describe your survivor 75 words or less to be published. *We will contact you if alterations are required.
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To finalize your reservation please select payment option. Selection will not be guranteed until full payment is made. * No Refunds
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Zelle:
katricebrinson@gmail.com
Cashapp: $kleanplate7
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