SUNSET FORM

June 8 – June 9, 2007

7:00 pm – 8:00 am

Grand Island High School

(Ph) 774-8978

Team Polka Dot Chix is sponsoring the First Annual Sunset Tent. During the Relay, you will be able to walk through the tent and view pictures of loved ones and friends that have been lost to this terrible disease. A sample is shown below. From the picture that you provide to us, (any size is fine) we will make a new picture

(4 X 6) with their name, date of birth (sunrise) and date of their passing. (sunset) Please no professionally taken pictures will be accepted as to follow the copyright laws.

I would like to honor the life of someone I have lost to cancer. I understand that their picture will be hung at the Sunset Tent during the 2007 Relay. I have enclosed their picture with the understanding that it will be returned to me.

v My gift of $5.00 is in memory of: (please print clearly)

__________________________________________

(FULL NAME AND FORM OF CANCER)

__________________________________________________

(DATE OF BIRTH AND DATE OF PASSING)

As visitors leave the tent, they will be able to purchase a helium filled balloon ($1.00 each) with a blank card attached to it. The card can be filled out with a personal message and upon leaving the tent; they can send it off to up above. This part is optional and you do not need to purchase the balloon.

Pictures can be sent to : Team Polka Dot Chix, 98 Pellamwood Court, Grand Island, NY 14072

Please return original picture to: ___________________________________ ___________________________________ ___________________________________