Light The Night 2012
National Capital Area
PARTICIPANT DONOR FORM
Please enclose this form with every batch of donations you submit to Light The Night. Without this
information we will not be able to credit these funds to your fundraising total. Upon receiving these funds (510 days) these donations will be reflected on your fundraising page.
Participant Name:_________________________________________________________
Address:________________________________________________________________
City:_____________________________ State:__________ Zip Code:________________
Event: Light The Night 2012
Walk site:________________________ Team Name:_____________________________
In the box below, please summarize your donations.
# of Enclosed
Donations
Payment Type
Total Amount
___________
Checks ONLY
$____________
IMPORTANT: If you have cash donations to submit, please deposit the cash and write us a personal check. We
cannot accept cash donations via mail.
All checks should be made out to The Leukemia & Lymphoma Society or LLS.
Mail this form and all checks to:
The Leukemia & Lymphoma Society
Attn: Light The Night 2012
5845 Richmond Highway, Suite 800
Alexandria, VA 22303
MATCHING GIFTS: Matching Gift Forms, and applicable copies of donations being matched, should be sent
directly to The Leukemia & Lymphoma Society at 5845 Richmond Highway, Suite 800 Alexandria, VA 22303.