Pink DYMONS 8th Annual Cancer Walk/Run & Community Festival Registration Form

Pink DYMONS 8th Annual Cancer Walk/Run & Community Festival Registration Form

PARTICIPANTS are NOT required to participate in the 5k walk/run. Availavible options: Hopeful Half Mile or Miracle Mile.
Date: September 28,2024
Location: 300 Ruth Street Spring Lake NC 28390
Gates open @ 7:00 AM

Team registration is welcome and encouraged! Show your team spirit by wearing sprit gear,tutus, face painting, etc. CASH PRIZE FOR THE TEAM WITH THE MOST REGISTERED PARTICIPANTS!
Participant Information

Please complete all sections.
Full Name

First NameLast Name
Age
Date of birth

MonthDayYear
Date
Gender
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
T-Shirt Size

XSSMLXL2X3X4XYouth SYouth MYouth L
Emergency Contact Details
Contact Person

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
Have you or a loved one been diagnosed with any type of cancer before?

YesNo
If you answered yes. Please select the type of cancer.

Breast CancerProstate CancerKidney CancerThyroid CancerBladder CancerColon and Rectal CancerEndometrial CancerLeukemiaLiver CancerLung CancerMelanomaNon-HodgkinLymphomaPancreatic CancerOther
Payment Information
Team Name (If you are participating with a team,
Waiver & Release
I confirm that I am in good physical condition. I don't have any medical condition or medical history that will affect my participation in this event. I acknowledge that this cancer walk requires physical activity and there are possible risks. I release Pink DYMONS and /or the cancer walk/commuity festival event organizers from any liabilities in the event of an accident, illness, or injury. I confirm that all information in this registration form is accurate and true.

My Products

Registration $30.00

Tshirts available while supplies last.

Quantity

Total $0.00

Payment Methods

Credit Card

Cash App Pay

Signature

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Date Signed

MonthDayYear
Date
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Pink DYMONS 8th Annual Cancer Walk/Run & Community Festival Registration Form

Participant Information

Emergency Contact Details

Payment Information

Waiver & Release

Payment Methods