Relay for life Honor Roll
Your
Name____________________________________________________
Address_______________________________________________________
Phone________________________________________________________
The name you wish to honor
on Buford Masonic Lodges Relay for life
Banner, PLEASE PRINT
CLEARLY
__________________________________________________
Circle which applies:
In Memory of
In Honor of
Survivor
Supporter
This application must be
accompanied by 2 separate checks, 1 in the amount of your donation above
$25.00, made out to
American Cancer Society, and 1 for
$5.00 made out to Buford Masonic
Lodge. The $5.00 is for the banner cost, any funds left above the cost of
the banner will be donated to Relay for Life as a group donation in the Name of
Buford Masonic Lodge #292
You can mail this
application along with payment to
Dan Dacus SW
Flowery
Or bring to lodge meeting