Lights Out on Cancer Entry for Presentation
Please fill out the form below with information about your person that you would like to have in the presentation. Thank you. (If you have had your person in the presentation in the past, they are still in there. If there are edits or corrections that need to be made, please let me know) You can contact me at
Email address *
Name of person that you would like in the presentation *
Your answer
Type of Cancer he/she has or had
Your answer
Age of the person
Your answer
Are they in remission, receiving treatment, or have they passed
Your answer
Name of person making this request, please include your name and contact information in case there are any questions.
Your answer
If you have a photo to add or update, please send the image to Mrs. Coffman at
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