Gifts in Memory

It is our desire and intention to recognize at our Race Against Time 5K those who have lost their lives to addiction. As part of the event, we will have a special memorial with the names and dates of life for those individuals we have lost.

We want to make it available to anyone, whether or not they have been a part of Life Challenge, to give in memory of a lost loved one.

Contribution Amount $ *

Total Amount

Email Address *

Memorial Information

Please make my donation in the name of:

In Honor of In Memory of

Select an option to reveal honoree information fields.

First Name

Last Name

Birth Date

Deceased Date

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

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Gifts in Memory