Mammogram Pledge (November 2021-June 2022)

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All returned forms will be entered into a random monthly drawing for mammograms completed November 2021 to June 2022. The winners will receive a monetary donation.

Thank you,
Psi Epsilon Omega Chapter
Alpha Kappa Alpha Sorority, Incorporated®

Email *

Important Dates to Remember!

1. January pledge forms due February 5, 2022
2. February pledge forms due March 5, 2022
3. March pledge forms due April 5, 2022
4. April pledge forms due May 5, 2022
5. May pledge forms due June 5, 2022

** June 1-9 pledge forms are due by June 10, 2022 - the winner will be announced during the week of June 12, 2022 **

First and Last Name *

Phone number *

Mammogram Performed date *

Are you a member of Psi Epsilon Omega *

yes

Send me a copy of my responses.

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