Kites for a Cure™

(in partnership with GC for a Cure)

* required information
Registration 
Registration Information
Title:
First Name:*
Last Name:*
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:
Birth Date:(mm/dd/yyyy)
School:
Do you have experience with lung cancer?
If so, please provide details on your experience:
Registration Fees
1 Kite:
@ $20.00 = $
Family of Flyers:
Kites for the family (up to 5 participants)
@ $100.00 = $
Additional Donation
Help support lung cancer research by making an additional contribution.
Amount:$
Additional Information
I am making this gift:
Please send a letter to: (honoree or family member name):
Mailing address:
City:
State:
Zip:
Name: