Pink Affair Model Registration Form

Model headshots will be taken on Wednesday, October 7, 2025 at the Lewis Hall Singletary Archbold Cancer Center.

Times are:

12:30pm-1:30pm and 5:00pm-6:00pm.
Name

First NameLast Name
Age
Type of Cancer
Number of years as a survivor
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Clothing Information
Dress Size
Pant Size
Shirt Size
Please list three interesting facts about yourself that you would like to share with the audience.
How has your experience with cancer changed how you live your life?
Is there anyone you would like to thank for helping you during your cancer journey?
Do you have any advice you would like to share with the audience or inspirational quotes that have motivated you to get where you are today?
Should be Empty: