Breakthrough Breast Cancer - Go Pink

Go Pink at School - Please register your details

Register for Go Pink today and we'll send you your free fundraising pack containing everything you need to Go Pink with a bang! Please complete your details below and your pack should be with you within 10 days. If you have any questions in the meantime, please don't hesitate to contact us on 08080 100 200 or e-mail gopink@breakthrough.org.uk. Thank you!

Please note: fields marked with are mandatory.

Your details
Title:
First name:
Surname:
Date of birth (DD/MM/YY):
Are you:
Your school's details If you are going pink at school please provide us with your school address.
School name:
What type is your educational establishment:
If other educational body please give details here:
Address Line 1:
Address Line 2:
Address Line 3:
Town:
Postcode:
Telephone Number:
If you are happy for us to contact you by e-mail, please provide it below.
Email:
It is important for Breakthrough to know how you heard about Go Pink, please select one of the options below:
How did you hear about Go Pink?
If other source please give details here:
Why have you chosen to support Breakthrough Breast Cancer?	I have had breast cancer I know someone who has had breast cancer I have lost someone to breast cancer I wanted to take part in a fundraising activity Other
If other reason please give details here:
We will keep a confidential record of your answer if you choose to tell us about your relationship to breast cancer. We will take great care to safeguard this information, and process it according to the 1998 Data Protection Act. Privacy Policy. Breakthrough may phone or write to you about your support and to keep you updated on the work you are helping to fund. If you prefer not to be contacted, call us on 08080 100 200.

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Go Pink at School - Please register your details

Your details

Your school's details