Light The Way To A Cure
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 luminary 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. Complete and return this form to the address below:



We don't currently have electronic form submission capabilities, but you can fill this form out, hit your print button, and then mail it in along with your payment. Look for online forms in the future.

Name:
Address:
Address 2:
City: State: Zip:
Phone:
In honor of in memory of
In honor of in memory of
In honor of in memory of
In honor of in memory of
In honor of in memory of
Total Enclosed:
Make checks payable to:
The American Cancer Society
$10 per luminary please.

Mail completed form along with your donation to:

Renee Dykes
5404 Broadway
Great Bend, KS 67530

Thank You.

Please come join us for our Luminary Ceremony at 9:00 PM on Friday evening, June 13th, 2003.

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