Hillsborough Relay For Life

Celebration of Life
Registration

Name:

Address:

City:

State

Zip:

Phone:

Home

Work

Email:

T-Shirt Size:

YM S M L XL XXL XXXL

At what age were you diagnosed with cancer?

Are you between the ages of 3 and 18? Yes No

VOLUNTEER OPPORTUNITIES

Please check one of the following if you would like to be
contacted about volunteering:

Relay For Life

Be involved on a team

Be on the planning committee

Participate in the survivor lap

Advocacy:

Be a part of the Action Network

Patient Service Programs

Reach to Recovery Program

Man to Man Prostate Support Group

Road to Recovery Program

Tell a Friend Program

OPTIONAL

If you would like the following to be read about you during the

Survivor Ceremony, please fill out below.

Type of cancer:

When did you find out you had cancer?

Month Year

	Please do NOT announce my name or anything about me during the ceremony.

Anti-spam quiz: What is 2+2?

The cancer survivor lap will take place:

date: Friday, may 2

Time: 6:45 p.m.

location: Orange County Speedway

survivors should arrive no later than 6:15 p.m.

cancer survivors, please be at the survivor registration area by 5:30 p.m.

returning survivors, please bring the white sashes you received last year!