Relay for Life of Statesville is 
30 Years STRONG Walk~Hope~Cure
Join Us at the Survivor & Caregiver Dinner 
Thursday, May 7, 2015 
                      @ Statesville Civic Center at 6pm

Relay For Life brings together more than 5.5 million people to celebrate the lives of those who have battled cancer, to remember loved ones lost, and to empower individuals and communities to fight back against the disease. Dinner is free for all cancer survivors. One caregiver/guest may attend with each survivor for $5. Please complete and mail this form and your $5 check (for a caregiver/guest, if applicable, payable to American Cancer Society) no later than Friday, May 1, 2015 
To: Peggy Anderson 233 Marble Road, Statesville, NC 28625. 

Please provide the following information to register for the dinner:  
 
Today’s Date ______________________    Years of Survivorship______________ 
 
Your Name________________________________________________________________ 
 
Address___________________________________________________________________ 
 
City_________________________         State__________         Zip___________________ 
 
Phone ____________________________________________________________________ 
 
E-mail Address _____________________________________________________________ 
 
T-shirt size (adult)  S____   M____    L____    XL____    2XL____   3XL____  4XL____    5XL____ 
 
Name of Guest____________________________________________________ 
(Space is limited to one caregiver/guest per survivor – no exceptions, please. There is a $5 caregiver/guest fee.) 
 
TO REGISTER AS A RELAY PARTICPANT AND SURVIVOR, PLEASE COMPLETE THE FOLLOWING (otherwise you will be registered as a Survivor only): 

My Team Name: ____________________________________________________________ 
 
My Team Captain: ___________________________________________________________ 
 
Please complete and mail this form and your check no later than Friday May 1, 2015  
To Peggy Anderson, 233 Marble Road, Statesville, NC 28625

Cancer survivors are the reason we Relay, so help us kick off our event by participating in the Opening Ceremony and Survivor Lap. We invite you to take this opportunity to be supported by your community and, in turn, to bring hope to others facing cancer. This year’s event will be held on Friday, May 15-16, 2015 at the Iredell County Fairgrounds. Gates open at 3 p.m. Opening ceremonies and the survivor lap begin at 6 p.m. The Luminaria Ceremony will be held at dark. Closing ceremonies begin at dawn on Saturday. Please join us! For more information please visit our website at www.relayforlife.org/statesvillenc