Print and mail
Name: __________________________________________________
Corporation: _____________________________________________
Address: ________________________________________________
City/State/Zip Code: ________________________________________
Telephone: _______________________________________________
eMail: ___________________________________________________
Corporate Sponsor: ___ $660
Gold Sponsor: ___ $66 + $66
Silver Sponsor: ___ $66
Rider Sponsor: ___ $33
Helper Sponsor: ___ Prayer ___ Donation of $________
Send all Sponsorships to:
Rodger L. Fox
806 Hardin Ave.
Jacksonville, IL 62650
Phone: 217-473-1525
Make all Checks payable to:
"Relay for Life" Jacksonville
American Cancer Society Jacksonville