Susan G. Komen® - Survey - FORD Warrior in Pink 2026 Nomination Form

FORD Warriors In Pink are ambassadors for the 2026 West Palm Beach Susan G. Komen MORE THAN PINK Walk. FORD Warriors in Pink are expected to:

Form a fund-raising team for the 2026 West Palm Beach MORE THAN PINK Walk Serve as an ambassador of the MORE THAN PINK Walk and Susan G. Komen, helping to promote the event and encourage fundraising.

Act as an ambassador for the MORE THAN PINK Walk promoting the event. Warriors will be provided social media messaging which they can use or create their own content.

Share your personal journey in the media, social content and at public events.

Participate in a group and individual photo shoot and work with the communications team on content that will be created to help promote you as a Warrior in Pink.

Attend 2026 the West Palm Beach MORE THAN PINK Walk, January 31, 2026 at Meyer Amphitheatre

1.

NOMINEE CONTACT INFORMATION

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Name:

First Required	Middle Required	Last Required

*

Email: Required

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Street 1: Required

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Street 2: Required

*

City/State/ZIP:

City Required	State Required	ZIP

*

Phone Number: Required

Date of Birth:

Yes, I would like to receive e-mail from Susan G. Komen®

Yes, I would like to receive postal mail from Susan G. Komen®

2.

Question - Not Required - Best time to call:

3.

Question - Not Required - If selected, would the Nominee be comfortable representing Komen as an Ambassador at community events (subject to date availability), on social media and in the media? We will arrange for a photo shoot for the FORD 2026 Warriors In Pink and we will be using these images in our promotions.

Yes

No

4.

Question - Not Required - Please select "Yes" to confirm your understanding and consent.

Yes

No

Please select “Yes” above to confirm your understanding and consent:
I understand the responsibilities of a FORD Warrior in Pink as described above and am willing to fulfill these expectations if selected. I consent to the collection and processing of my information for the purpose of the FORD Warriors in Pink selection process. I understand that interviews will be conducted in early August 2025 and require me to appear in person. I grant Susan G. Komen and FORD the right to use my name, likeness, image, and story in promotional materials if I am selected and agree to sign a publicity release. I understand that my personal health information is voluntary, and I control what I choose to share in my survivor story. I have read and agree to the Privacy Policy.

5.

NOMINATED BY (Self-nominations will be accepted):

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Name:

First Required	Last Required

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	State Required	ZIP Required

*

Phone Number: Required

Yes, I would like to receive e-mail from Susan G. Komen®

Yes, I would like to receive postal mail from Susan G. Komen®

Questions? Please reach out to:
Danielle Crouch, Development Manager, West Palm Beach
(561)486-6403

DCrouch@komen.org

Thank you for your submission!
*Interviews will be conducted in early August 2025