The document advertises an upcoming Relay for Life event where hundreds of candles will light up the night in tribute to cancer patients and survivors. Participants can purchase luminaries to honor survivors or remember loved ones lost to cancer. The luminaries will line the track after sunset on April 30th. Donations of $5 per luminary or 3 for $10 are requested to participate in the meaningful ceremony.

1. Light the Night With Luminaries
Montgomery County Relay for Life East Montgomery High School
th st
April 30 – May 1 6pm – 6am
There will be hundreds of candles lighting the night at East Montgomery High School Track – each one a tribute to a cancer patient.
Candles displaying the names of all those being remembered and honored will be lining the track after sunset on Friday, April 30th,
2010. This will be a meaningful and inspirational ceremony and we would like to invite you to participate in this year’s event by
having a candle lit in “Memory” of a loved one or in “Honor” of a survivor.
Survivor: _____________________________________________
Given by: ____________________________________________
In “Honor” of a Survivor
Each luminary requires a $5 donation Phone Number: _______________________________________
or 3/$10. Acknowledgment Card to be sent? Yes or No (Please Circle)
I would like a candle lit in honor of each Send Acknowledgment To:
of the following survivors: Name:_____________________________________________
Address: ____________________________________________
City: ________________________ State: ____ Zip: ________
Survivor: _____________________________________________ Survivor: ____________________________________________
Given by: ____________________________________________ Given by: ____________________________________________
Phone Number: _______________________________________ Phone Number: _______________________________________
Acknowledgment Card to be sent? Yes or No (Please Circle) Acknowledgment Card to be sent? Yes or No (Please Circle)
Send Acknowledgment To: Send Acknowledgment To:
Name:_____________________________________________ Name:_____________________________________________
Address: ____________________________________________ Address: ____________________________________________
City: ________________________ State: ____ Zip: ________ City: ________________________ State: ____ Zip: ________
In Memory of_________________________________________
Given by: ____________________________________________
In “Memory” of a Loved One
Each luminary requires a $5 donation Phone Number: _______________________________________
or 3/$10. Acknowledgment Card to be sent? Yes or No (Please Circle)
I would like a candle lit in memory of Send Acknowledgment To:
each of the following people: Name:_____________________________________________
Address: ____________________________________________
City: ________________________ State: ____ Zip: ________
In Memory of_________________________________________ In Memory of_________________________________________
Given by:____________________________________________ Given by: ____________________________________________
Phone Number: _______________________________________ Phone Number: _______________________________________
Acknowledgment Card to be sent? Yes or No (Please Circle) Acknowledgment Card to be sent? Yes or No (Please Circle)
Send Acknowledgment To: Send Acknowledgment To:
Name:_____________________________________________ Name:_____________________________________________
Address: ____________________________________________ Address: ____________________________________________
City: ________________________ State: ____ Zip: ________ City: ________________________ State: ____ Zip: ________
Make checks payable to: American Cancer Society If you would like your donation credited to a
particular Relay team, please note that here.
MAIL TO: JIM RUSSELL-OWEN
1011 PAGE STREET
TROY, NC 27371