Luminaria Form Donor name ___________________________ Address ______________________________ City ___________ State ____ Zip ______ Honoree ____________________ Memory __ Honor __ Honoree ____________________ Memory __ Honor __ $5 suggested donation per luminaria amount enclosed $______ # of luminaria __ Make checks payable to American Cancer Society return form to a Relay for Life team member Participants name ________________________ Team name ________________________________ or mail to: Molly Yoak 186 Hospital Drive Grantsville, WV 26147