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I want to form a Relay For life team! |
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I am a Cancer Survivor |
Name__________________________________________________
Address________________________________________________
City, State, Zip___________________________________________
Day Phone ( )_____________________________________
Employer_______________________________________________
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I
am unable to participate in the Relay for Life. Please accept my tax deductible donation of $___________ |
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Enclosed is my check made payable to the American Cancer Society. |
[ ] Visa [ ] Mastercard [ ] American Express
Card#_____________________________ Expiration Date ______________
Signature_________________________________________________________
Day
Phone (
)___________________________________
IN
CASE WE NEED TO CONTACT YOU