Braxton's Relief Remembrance Walk Luminary Registration

Friday, October 9th | 6:30pm | Please fill out this registration form and click submit.

Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Luminary Purchase & Donations

Donations received will go towards the Braxton’s relief ministry. Ministry funds will be used for our mission in helping families and financially after a loss. In addition to helping local families we would also like to be able to help the local hospitals provide comforting care to families who have lost their child. Braxton's Relief Ministry cares about our community and wants to provide awareness and support in any areas we are able.

Luminary In Memory Of

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Qty. of Luminaries

0 (0) 1 ($10.00) 2 ($20.00) 3 ($30.00) 4 ($40.00) 5 ($50.00) 6 ($60.00) 7 ($70.00) 8 ($80.00) 9 ($90.00) 10 ($100.00)

Amount

Optional Donation to Braxton's Relief Ministry

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Friday, October 9th | 6:30pm

Please fill out this registration form and click submit.

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