EmailMe Form - Luminaries for Loved Ones

Donation Amount ($5 minimum per name in memory).

$ Dollars

Payment Method

I'll donate via Paypal online

I'll mail a check to LLHS

I'll drop off my donation at LLHS

The donation amount you entered above tells LLHS what you plan to donate, but it does not indicate actual payment. Please tell us your preferred method of payment, and take that step AFTER you have submitted this form. If you're mailing, the address is 231 Woodland Beach Rd Lake Mills 53551

Donor Name *

Prefix First Last

Write the donor name(s) as you would like them to appear in the program. You may enter more than one first name in that field.

Email *

Address

Street Address City State / Province / Region Postal / Zip Code Country / Region

Choose:

In Memory

In Honor

Name as you'd like it to appear on Christmas concert program

Choose:

In Memory

In Honor

2nd Name as you'd like it to appear on Christmas concert program

Choose:

In Memory

In Honor

3rd Name as you'd like it to appear on Christmas concert program

Choose:

In Memory

In Honor

4th Name as you'd like it to appear on Christmas concert program

(if you have more than 4, please send an email with your name and additional memorial names to bvredeve@llhs.org.) Please proceed to donate securely online via the page that appears next, or send in a check to the LLHS office before the RSVP date