Survivor Registration Form - Invitation

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Name _______________________________________ Address _______________________________________ City _________________________________________ State ____________________ Zip_______________ Phone_______________________________________ Email__________________________________________ T-shirt size (Youth Small – 3XL) ________ Type of Cancer________________ Year Diagnosed_____ (One t-shirt per pre-registered survivor.) (Optional) HAVE YOU EVER HEARD THE WORDS - YOU HAVE CANCER? YOU ARE A CANCER SURVIVOR… YOU ARE NOT ALONE. YOU’RE INVITED! THE AMERICAN CANCER SOCIETY WOULD LIKE TO HONOR AND CELEBRATE YOU AT THE RELAY FOR LIFE OF WESTERN BERKS! Please join our survivor celebration on Friday, June 10 th at Wilson Senior High Stadium – Grandview Blvd, West Lawn Schedule of Events: Free t-shirt & gift bag pick up any time after 12:30pm Dinner, Cake, & FUN 4:30-6:30pm (Free for you and your guest) Uplifting Survivor Celebration 7:00pm RSVP today to save your seat at the party! Please return completed form to: American Cancer Society, Berks Unit – 498 Bellevue Avenue – Reading, PA 19605 OR Fax to (610) 921-9521 (ATTN: Jessie Rivera) OR email to [email protected] If you would like more information, please call Mabel Davis 484-769-4879

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Please join our survivor celebration on Friday, June 10 th at Wilson Senior High Stadium – Grandview Blvd, West Lawn Schedule of Events: Free t-shirt & gift bag pick up any time after 12:30pm Dinner, Cake, & FUN 4:30-6:30pm Uplifting Survivor Celebration 7:00pm T-shirt size (Youth Small – 3XL) ________ Type of Cancer________________ Year Diagnosed_____ (One t-shirt per pre-registered survivor.) (Optional) (Free for you and your guest) Name _______________________________________

Transcript of Survivor Registration Form - Invitation

Page 1: Survivor Registration Form - Invitation

Name _______________________________________ Address _______________________________________ City _________________________________________ State ____________________ Zip_______________ Phone_______________________________________ Email__________________________________________ T-shirt size (Youth Small – 3XL) ________ Type of Cancer________________ Year Diagnosed_____ (One t-shirt per pre-registered survivor.) (Optional)

HAVE YOU EVER HEARD THE WORDS - YOU HAVE CANCER? YOU ARE A CANCER SURVIVOR…

YOU ARE NOT ALONE.

YOU’RE INVITED!

THE AMERICAN CANCER SOCIETY WOULD LIKE TO HONOR AND CELEBRATE YOU AT THE RELAY FOR LIFE OF WESTERN BERKS!

Please join our survivor celebration on Friday, June 10th at Wilson Senior High Stadium – Grandview Blvd, West Lawn

Schedule of Events: Free t-shirt & gift bag pick up any time after 12:30pm

Dinner, Cake, & FUN 4:30-6:30pm (Free for you and your guest)

Uplifting Survivor Celebration 7:00pm

RSVP today to save your seat at the party!

Please return completed form to: American Cancer Society, Berks Unit – 498 Bellevue Avenue – Reading, PA 19605 OR Fax to (610) 921-9521 (ATTN: Jessie Rivera) OR email to [email protected]

If you would like more information, please call Mabel Davis 484-769-4879