Honor a Loved One with a Luminaria

Whether you participate in person or in spirit, here's your chance to support the American Cancer Society's fight against cancer.  Keep the fire of hope burning by purchasing a luminaria candle in memory of someone lost to cancer, in honor of someone still fighting, or in special recognition of someone who has beaten this dreaded disease.

Print this page, fill it out and mail it with your donation to:

Cindy Petz
Box 142
Beemer, NE 68716

Make checks payable to American Cancer Society

Luminaria are also available through any Relay Team member and at CharterWest National Bank in West Point.

To have your Luminaria included alphabetically at Relay 
please return this form & donation by Saturday, July 14th, 2007.

Relay For Life Luminaria Order Form

From___________________________________________

In Memory Of___________________________________
(in memory of those no longer with us)

In Honor Of_____________________________________
(someone currently battling cancer or cancer survivor)

Team Captain's Name_____________________________
(or team name)

Amount Enclosed $______________________ 
          Circle One:    CASH    CHECK  
Minimum contribution - $10.00 per name
*If receipt requested, include name and address below

Relay For Life Luminaria Order Form

From___________________________________________

In Memory Of___________________________________
(in memory of those no longer with us)

In Honor Of_____________________________________
(someone currently battling cancer or cancer survivor)

Team Captain's Name_____________________________
(or team name)

Amount Enclosed $______________________ 
          Circle One:    CASH    CHECK  
Minimum contribution - $10.00 per name
*If receipt requested, include name and address below