Partner Registration Form

Thank you for your interest in the Pearl of Wisdom Campaign to Prevent Cervical Cancer! By completing and submitting the information below, your organization is signing on as a Partner to the campaign.

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:

Organization's Logo:

Please upload your organization's logo to be featured on our new partners page. The image must be a gif, jpg, or png and under 800KB.

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 and symbol:

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 authorized to commit the organization?:

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

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Copy the characters (respecting upper/lower case) from the image.

Partner Registration Form

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Shannon Miller Supports the Pearl of Wisdom Campaign

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Partner Registration Form

Primary links

Login

Our Blogger Friends

Shannon Miller Supports the Pearl of Wisdom Campaign

Submit a Photo

Get your Pearl of Wisdom

Join the Campaign