Please print out this form and mail it to the address listed below.    Back to web site.

Ken,

I want to join you in the fight against cancer. I have checked what I will do to help:
Make a contribution:   ______ $25   ______ $50   ______ $100   ______ $250
Make check payable to the American Cancer Society and return to address below.
Help you raise money from others.

The best number at which to call me is _______________________.

Best time to call __________________________________.
Participate at the Relay for Life Event at South Lakes High School on June 8-9.
Let me know how I can help.
Name

Address

Telephone

Email

_____________________________________________________________________

_____________________________________________________________________

(h)_______________________________   (w)_______________________________

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Mail to Relay for Life, c/o Delegate Ken Plum, 2073 Cobblestone Lane, Reston, VA 20191.