Become a Paint Port Pink community partner

Paint Port Pink Community Partner Commitment Form

Think pink and become a community partner by filling out the form below. For more information, contact Stu Vincent at svincent@northwell.edu or call (631) 476-2723.

Contact Name*
First Last
Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Please provide both phone and email address so we can communicate and send Paint Port Pink promotional material and information.
Email*

Please provide both phone and email address so we can communicate and send Paint Port Pink promotional material and information.
Website
YES we will commit to being a supporter of Paint Port Pink via the following:
(Please check all of the boxes that you are committing to)
- Display pink lights, provided by Mather Hospital, in your store front/business windows
- Offer a pink promotion/fundraiser - For the month of October (proceeds to benefit Fund for Uninsured at Fortunato Breast Health Center) Example: For the month of October donate back 10% of sales or sell “pink” items and donated back proceeds. Be creative! Use your imagination!
Pink Lights*
- I have pink lights from last time
- I need pink lights
Window Decorating Contest
- I'd like to participate in the Window Decorating Contest