AVON 39 Returning Media Spokesperson

Share Your AVON 39 Story

Share Your AVON 39 Journey

Returning Media Spokesperson Survey

Note: For privacy reasons, you will have 20 minutes to fill out the form below. We recommend typing all of your answers in a separate document first, then copying and pasting them into the form below.

Please provide the information below.

If you have previously registered, please login here to prepopulate your information.

Name:

First Required	Last Required

Email: Required

Question - Required - Phone Number (best number to reach you at before the walk, please enter digits only)

Question - Required - Phone number (your cellphone during AVON 39 weekend, please enter digits only)

Question - Required - Which AVON 39 events are you participating in? Please select all that apply.
Please make at least 1 selection from the choices below.

	Houston
	Washington, DC
	Boston
	Chicago
	San Francisco
	Santa Barbara
	New York

Question - Not Required - What is your personal connection to AVON 39 The Walk to End Breast Cancer and what does the #powerof39 mean to you?

Question - Not Required - Are you a challenge or adrenaline seeker? Yes/No

Question - Not Required - Share some of the most physically challenging experiences you've participated in.

Question - Not Required - How are you preparing for the AVON 39?

Question - Not Required - Is there anything you would like to share? We have access to the information you provided in last year's Media Walker form.

Select City

Which city would you like to register for?

Santa Barbara

Sep 12-13, 2015

New York

Oct 17-18, 2015

Houston

Apr 23-24, 2016

Washington DC

April 30-May 1, 2016

Chicago

Jun 4-5, 2016

Boston

July 9-10, 2016

San Francisco

Jul 23-24, 2016

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