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American Cancer Society  Relay For Life West Bend - 2006
A Community Fundraising Event to Fight Cancer

 

Luminaria Order Form

2006 WEST BEND RELAY FOR LIFE

The Luminaria Ceremony offers everyone an opportunity to honor someone who is living with cancer or remember someone who has lost their battle. The bags will line the path on August 4th at 10 p.m. Everyone is invited to attend.

Your suggested donation of $5.00 per bag will place a luminaria along the pathway to memorialize or honor someone you love. Personal messages can be added to the luminaria along with the individual’s name.                                                    

Please check one

          Put name and message for each bag in the space below

___ In honor of
___ In Memory of

Bag 1:

 

___ In honor of
___ In Memory of

Bag 2:

 

___ In honor of
___ In Memory of

Bag 3:

 

___ In honor of
___ In Memory of

Bag 4:

 

Your Name: ___________________________________
Address : _____________________________________
City: ____________________  State ________  Zip ________
Phone: ____________________
_______________________________________________________

Please print out this form, fill it out and return form with a minimum $5.00 donation per luminary (checks payable to American Cancer Society) to:
American Cancer Society
Relay For Life in West Bend
PO Box 902
Pewaukee, WI 53072

Pronunciation Guide

There is a possibility that names will be read at this year’s Relay. If they are read, and any of your names are difficult to pronounce, please help us by including the phonetic pronunciation below. Thank you.

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