All cancer survivors are invited to celebrate life and the hope for a cure by joining in the Relay For Life Survivor Ceremony.  The survivor lap symbolizes the courage survivors and their families display in their lives everyday. All families, friends and caregivers are invited to join you in the Survivor Ceremony and at the Relay For Life.

To register yourself as a survivor and to participate in the survivor lap please fill out the form below or CLICK HERE To print this form and mail it to us.

I am a cancer survivor and would like to attend the survivor reception.

My first name is: Last name:

Address:  City:  State:  Zip:

Phone: E-mail address: