REGISTRATION FORM for the EMAC SMEARATHON (walk, fitness, free screening) sponsored by ACCESS WOMEN NETWORK and The W Community
  • (self exam or mammogram or other)
  • (walk, fitness and all day screening sessions)

Note

1. The amount below is required for registration. One person N5000 Group of 10 N45,000 You will be given a T-shirt, bracelet, mug, snacks/drinks and goody bags. 2. You could also donate N5000 or more to enable more people to be screened for and vaccinated against Cervical cancer. ( ) Yes I would like to contribute N5000 or N…………………………. (pls make cheques payable to exquisite magazine services limited) Payment can be made into ACCESS BANK , Account number : 0717989522. (Exquisite Magazine Services Limited). All sponsors get a raffle ticket to be in a draw. Thanks for being part of EMAC Smearathon 2017 sponsored by Access Women Network and remember to bring this form and your deposit slip on the 16th of September or email it to Emac@exquisitemag.com