Author: ACS User

Luminaria Order Form Relay For Life of Southwest Pensacola RelayForLife.org/perdidofl April 9, 2016 4pm-12am

When the sun goes down at every American Cancer Society Relay For Life event, hope shines the brightest. During the Luminaria Ceremony, hundreds of luminaria light the track to celebrate the lives of those who have battled cancer, remember those who have lost their battle, and fight back against the disease that has taken too much. This ceremony of light symbolizes the hope and perseverance with which we all continue to fight.
You can give to the American Cancer Society and keep the flame of hope lit by ordering a luminaria in memory of someone lost to cancer or in honor of someone still fighting or who has beaten the disease.
Please send your tax-deductible donation payable to the American Cancer Society and the bottom portion of this form to:
American Cancer Society 5401 Corporate Woods Drive Suite 100 Pensacola FL 32504
To ensure delivery of your luminaria prior to the event, be sure to mail your donation along
with the form below by April 2nd, 2016
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Your name: _______________________________________________________________________________________
Address: _________________________________________________________________________________________
City, State, ZIP: ____________________________________________________________________________________
Email: ___________________________________________________________________________________________
In □ Memory □ Honor □ Support □ Appreciation In □ Memory □ Honor □ Support □ Appreciation of _________________________________________ of _________________________________________
Message (10 words maximum)__________________ Message (10 words maximum)__________________
___________________________________________ ___________________________________________
In □ Memory □ Honor □ Support □ Appreciation In □ Memory □ Honor □ Support □ Appreciation of _________________________________________ of _________________________________________
Message (10 words maximum)__________________ Message (10 words maximum)__________________
___________________________________________ ___________________________________________
In □ Memory □ Honor □ Support □ Appreciation In □ Memory □ Honor □ Support □ Appreciation of _________________________________________ of _________________________________________
Message (10 words maximum)__________________ Message (10 words maximum)__________________
___________________________________________ ___________________________________________
Payment method: □ VISA □ MasterCard □ AmEx □ Discover
□ Cash Card number:__________________________________
□ Check (payable to American Cancer Society) Name on card: _______________________________
Total amount enclosed: $ _____________________ Expiration date: ___/____ Code on back:___________