CIRCLE OF ROSES / "TRIBUTE TO COURAGE" BOOK
Use this form to commemorate someone in the Circle of Roses / "Tribute to Courage" Book
to be distributed at the 2007 Cattle Baron's Gala June 9th.
Minimum $75 donation per honoree, per page.
You may submit as many pages as you like.
Please fill out YOUR information (Please print clearly):
Name: ___________________________________________ Telephone Number: _____________________________
City: ___________________________________________ State: ______ Zip: _______________________________
ON A SEPARATE SHEET OF PAPER, TYPE OR PRINT CLEARLY YOUR MESSAGE
Please photocopy this form and submit a separate form and message sheet for each honoree.
**Note on the sheet "In Honor of (Name)" or "In Memory of (Name)"
**Text may be no more than 150 words.
**Tell us to whom we shall send an acknowledgement of your donation (Please Print Clearly)
I am ____/am not ____ enclosing artwork or a photograph to print with my message.
- If possible, please submit artwork or photographs as a .jpeg file on a disk or CD.
- If providing a paper submission, please supply artwork or simple text on unfolded, plain white
paper no larger than 8 1/2" x 11".
- We encourage children's drawings. For best clarity, submit black & white drawings made with
- Photographs may be in color or black & white.
- Attach a label on the reverse side of all photographs and artwork, including your name, address,
telephone number and name of person honored by the photograph or artwork
Return this form, your message sheet and any photography or artwork to:
The American Cancer Society Office
Attn: "Tribute to Courage" Book, 1301 S. Broadway, Tyler, TX 75701
Payment Information: $75 per honoree/per page
Please make your checks payable to: American Cancer Society OR you may pay by credit card:
Name as it appears on credit card______________________________________Signature______________________________
Check one: Master Card ________ Visa ________ American Express ________ Discover __________
Card # _________________________________________ Expiration Date ________________
I would like to make an additional donation in the amount of $ ________________
to the American Cancer Society.
Submissions must be received by March 15, 2007 due to print deadlines.
Inclusion in the invitation cannot be guaranteed after this date.
For more information about the Circle of Roses / "Tribute to Courage" book , contact the ACS office at 903-597-1383 or
Leslie Watson at 903-533-1066 or