LUMINARIA FORM
RELAY FOR LIFE 2017
Watauga High School
Friday June 16th 
A fund raiser of the American Cancer Society’s 
Relay For Life of Watauga County
 
HOPE LIGHTS THE WAY!  Luminaria, with honorees’ names prominently displayed on white bags, will provide a glowing inspiration throughout the night as they light the path around the track for Relay participants.  These Lights of Love allow us to pay tribute to the memory of our loved ones who have lost their battle with cancer and to honor those who continue their courageous fight.

Please fill out the form below and enclose $10 for each luminaria purchased.  Make your check payable to the American Cancer Society for the total amount due and mail to the address listed below, or give to a team member.  Your canceled check will serve as a receipt for your tax-deductible contribution.  One form may be used for multiple luminaria by completing items #1 through #4 on the first sheet only and attaching additional sheets as needed. Thank you for joining in our fight against cancer.  Hope begins with you.
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Your Name	________________________________________		 	 Amount Enclosed          

												 for LUMINARIA
	Address	________________________________________
			________________________________________			$_______________		
	Phone		________________________________________

PLEASE PRINT NAMES BELOW:				If you would like an acknowledgment sent to a family member, please print their name and address
In Memory of _______________________________ 	__________________________________________
								__________________________________________

In Memory of________________________________	__________________________________________
								__________________________________________

In Honor of _________________________________	__________________________________________
								__________________________________________
			
In Honor of__________________________________	__________________________________________
								__________________________________________
__________________________________________________________________________________________

Send form with contribution to:			Or Return to Team Member: 
						______________________________________	
Relay For Life of Watauga County 
American Cancer Society	                          Team Name: 		
4A Oak Branch Dr				_______________________________
Greensboro, NC 27407

It’s about being a community that takes up the fight......