Luminaria Order Form For Smsu

Team Name ________________________________ Participant Name ___________________________ Team Captain’s Name________________________

American Cancer Society Relay For Life of “Southwest Minnesota State University”

Luminaria Form The highlight of this event is the beautiful luminaria lighting ceremony held to honor survivors and to remember those who have lost their battle against cancer. These luminarias are left displayed throughout the night to remind participants of the incredible importance of their contribution. Guest speakers will also share their experiences with cancer and the need to eliminate this disease. Luminarias are white bags that bear the name of a cancer survivor (honor of), an individual who has lost a battle with cancer (memory of), as well as names of other people as a tribute or memorial. Participants are encouraged to dedicate a luminaria as a special remembrance to a loved one. They can be purchased for a $10.00 tax-deductible donation to the American Cancer Society. Please indicate if the luminaria is in “Memory of” or in “Honor of” a special person. Purchasers may choose to decorate the bags. Give them a bag and turn them in at Bank Night. You are responsible for collecting and returning any decorated bags.

ORDER FORM ON BACK

Number of luminarias








































x if given one to decorate


Memory of
Honor of
Memory of
Honor of
Memory of
Honor of
Memory of
Honor of
Memory of
Honor of
Memory of
Honor of
Memory of
Honor of
Memory of
Honor of
Memory of
Honor of
Memory of
Honor of
Memory of
Honor of
Memory of
Honor of
Memory of
Honor of

Choose One:

Team Member: _______________________

Name on Luminaria

PRINT CLEARLY

Team Name: ____________________________

♦Return this form and money to your team captain or drop it off at a Relay meeting. ♦Pick up Another Form and Continue!

Purchased By:

Luminaria Order Form