Luminaria Request Form
Santa Monica Relay For Life
Santa Monica College, Corsair Field

 

Instructions:

On Saturday, July 24, 2004 at Santa Monica College, Corsair Field, we will be holding a Relay For Life Luminaria Ceremony at 9:00 p.m. The Luminaria bags will line the track and will have the name of a person for whom the Luminaria was purchased. You may purchase a Luminaria in "honor" of someone who is battling cancer, or has survived cancer, or in "memory" for someone who lost his or her battle with cancer.


Donations for the Luminaria bags are $10.00 each. They will also be available the day of the event for $10.00 each.

Please fill out this form and mail to the address listed below.

Mail To:

American Cancer Society
Att: Santa Monica Relay
5731 W. Slauson Ave., Ste. 200
Culver City, CA 90230

Please make your check payable to:
American Cancer Society/SMRFL.

Thank you!


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Luminaria Form
Your Name & Phone Number:  
In Honor of/ In Memory of / In Gratitude:
(circle one)		  
Message: