2009 Mercer County Relay for Life

   Cancer Survivors’ Honoree Lap .

4:00 PM Saturday June 13th

 Yes, I want to proudly celebrate my survivorship!  

     T-Shirt Size: __S  __M  __L  __XL  __XXL  __XXXL

Name                                                                       Phone                                            

Address                                                                                                                         

City                                                                   State                            Zip                     

Length of Survivorship                               Type of cancer______________________

___Please send me additional information about Relay For Life  

Please mail this form to Sharon LaRue at 426 W Main St Celina, OH 45822

For more information or questions, please call Sharon LaRue at 419-586-5823

                                                                                              Must be pre-registered to be assured you receive the size of shirt needed.