Because I Matter: Breast Cancer Awareness Event

Thank you for registering for this event. If you have any questions, please contact Sophia Ottomanelli at ottoman2@illinois.edu.

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Contact Information

First Name

Last Name

Street Address

Street Address 2

City

State

ZIP

Daytime Phone

Evening Phone

E-mail Address

I grant the University of Illinois Extension the permission to disclose my identity and to reproduce and distribute videotapes, films, photographs, and transparencies of me and sound recordings arising out of the Cook County Nature Wellness Walk. This image (photo or video) may be used in Extension publications or to otherwise promote Extension programs as in posters, audio/video presentations, or other displays. The image may also be released to local news media to be used in connection with reporting on, promoting, or otherwise publicizing Extension programs.

Yes

Civil Rights Compliance - Participant Info

As part of our commitment to providing equal opportunities in our programming, University of Illinois Extension is required to collect and report overall statistics about the race, ethnicity, and gender of program participants. Your responses are voluntary and appreciated.

Gender

Ethnicity

Race