Your name                                                  Phone number                         

Address                                                                                                    

City                                                      State                  Zip                      

In honor of (cancer survivor or patient):                                                      

In memory of (deceased):                                                                          

In honor of (cancer survivor or patient):                                                      

In memory of (deceased):                                                                          

Team Name                                                                                                 

TOTAL LUMINARIA______         X $10 EACH=$                                            

A minimum of $10donation is requested for each Luminaria sold.

Please include your check made out to the American Cancer Society or cash and return to:Relay for Life of Mercer County, Jan Dues, 1114 Canterbury Drive Celina, OH 45822 If you need space for more names, please enclose a separate sheet of paper with all the information.  Please enclose picture if you would like

Relay For Life of Mercer County’s Luminaria service will begin at dusk on Saturday, June 13, 2009  at Lakeshore Park, Celina, Ohio

 Luminaries may also be purchased at the event. Everyone is welcome to come to RELAY FOR LIFE as a spectator and/or participant. Please call to find a Relay for Life in your community or visit www.cancer.org

o Please send me more information on Relay for Life!