Tribute of Light Ceremony Volunteer Form

Contact Name*
Address*
City*
State*
Zip*
Daytime Phone*
Evening Phone
Email Address*
Number of Adults in Your Party*
Number of Children in Your Party*
Volunteer Names*	Please list the names of all volunteers below.
Have You Purchased a glowing tribute from ACS?*	Yes No
If yes, would you like to carry this glowing tributein the ceremony? *	Yes No
If yes, what is/are the name(s) of the individual(s) for whom you purchased a glowing tribute?*
Please note: If you do not specify a name prior to November 10th, we cannot guarantee that you will carry the candle that you purchased in the ceremony. You may be given an alternate name to carry.
* Indicates a required field