ANNUAL PINK 5K RUN AND 1 MILE FUN RUN REGISTRATION
PRESENTED BY: Pink Alabama & Alpha Phi Alpha Fraternity, Inc. (Kappa Nu Lambda Chapter) Date: October 10, 2026 Time: 8:00AM- 10:00AM CST Venue: 17 Hightower Place, Florence, AL
$25 ENTRY FEE FOR 5K - $10 ENTRY FEE FOR 1 MILE FUN RUN
Select one:
5K Run
1 MILE FUN RUN
Survivor Walk
Name
First Name
Middle Name
Last Name
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
example@example.com
Contact Number
Format: (000) 000-0000.
Sex
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Male
Female
N/A
Date of Birth
In Case of Emergency
Emergency Contact:
First Name
Last Name
Relationship
Contact Number
Format: (000) 000-0000.
Payment Method
Cash
Check
CashApp
Credit Card/Debit
Release and Waiver of Liability - Assumption of Risk and Indemnity Agreement
In consideration of my participation in the 5K run/1 mile fun run, Survivor Walk, I, the undersigned participant, hereby acknowledge and agree to the following:
I am fully aware of the risks involved in participating in a 5K Run/1 mile fun run, Survivor Walk, and voluntarily assume all such risks.
I am physically fit and have no medical conditions that would prevent my participation in the 5K run/1 mile fun run, and Survivor Walk.
I agree to comply with all rules and regulations of the 5K run/1 mile fun run, and Survivor Walk.
I release, discharge, and hold harmless the organizers of the 5K run/1 mile fun run, Survivor Walk, their officers, directors, employees, volunteers, sponsors, and any other persons or organizations associated with the 5K run/1 mile fun run from any and all claims, damages, or injuries, including death, that may arise from my participation in the 5K run/1 mile fun run or as a result of my use of any facilities or equipment provided by the 5K run/ 1 mile fun run.
Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
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