By participating in School & Youth programs, students learn that they can make a change and raise money that will make a big difference in the lives of others. In over 27,000 schools across North America, kids are learning about service, leadership, philanthropy and the power of spare change. And thanks to their efforts, these kids are saving lives.

Register your school to participate in the School & Youth^SM Programs by filling out and submitting the form below. The Leukemia & Lymphoma Society (LLS) chapter staff person from your area will contact you shortly to confirm your registration and provide you with more information.

Because we are COPPA compliant, only school administrators, school representatives and students over 14 may submit their school.

*required fields

First Name*
Last Name*
Your Title
School Name*
School Address*
City*
State/Province*	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
Fax
Email*
Preferred Method of Contact*	EmailPhone

We are interested in participating in the following program: (Please note your local LLS Chapter may not offer all programs)* Pennies For PatientsPasta For Pennies (limited markets)HOP for Leukemia & Lymphoma (limited markets)Other

We would like to run the program on the following dates (recommended: a 3 week period in January, February or March)*

Number of students in your school*
Number of classrooms participating*

Our school is interested in kicking off our Pennies program with an assembly presented by LLS.

YesNoWe'd like more information

LLS staff are available to help plan your Pennies campaign!	Yes, I am interested in meeting with a School & Youth (S&Y) staff Yes, I am interested in S&Y staff meeting with my student group Yes, I am interested in a phone planning meeting I'd like to request more information about this
How did you hear about our School & Youth Programs	BrochureFaxFriendLetterOther

Our school has a student currently in treatment for a blood cancer. Please contact me with more information about the Trish Greene Back To School Program.

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