Be an inspiration. Be a shining survivor.

A shining survivor is a dedicated individual who provides inspiration and support to event participants.  A shining survivor is anyone who has been affected by a blood cancer.  It is in their honor that participants fundraise for The Leukemia & Lymphoma Society. 

Becoming a shining survivor is an easy way for patients and thier families to join in the fight for a cure. As a shining survivor we ask that you supply participants with your story and possibly your picture to help them stay focused on their fundraising goals.  Health permitting, attendance at event functions such as kickoff parties and receptions is recommended.

As a shining survivor, you will be asked to share your strength, courage and motivation with our participants and provide encoruagement.  In return, you will be welcomed into a community of individuals fighting for a cure, providing hope to those affected by blood cancers. 

If you are interested in being a shining survivor, please fill out the form below or contact the Society at (800) 742-6595.

*required fields

Complete the following form and it will automatically be e-mailed to The Leukemia & Lymphoma Society.  Feel free to contact us with any questions you have at (800) 742-6595.
First Name*
Last Name*
If under 18, parents' names
Address*
City*
State*	Choose a State/Province Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland And Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon
Zip/Postal Code*
Day Phone*
Email*
Date of Birth*
Type of blood cancer
Date of Diagnosis
Current Status (remission, undergoing treatment, etc.)
Family Information (siblings, pets, etc.)
Hobbies
Additional Comments
I am interested in getting involved with the Light The Night® Walk	YesNo
I am interested in getting involved with other events	YesNo