Tribute of Light Ceremony Volunteer Form

Contact Name
Street Address
City State Postal Code
Daytime Phone Evening Phone
Email Address
Number of People in Your Party
 Adults
 Children
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.

PLEASE BE PATIENT AFTER CLICKING "SUBMIT", AS REFRESHING THE PAGE
 WILL CAUSE THE FORM TO BE SUBMITTED MULTIPLE TIMES.