Nameplate

7th Annual Walk-a-thon
September 28th 2008 10am - 5 pm
 

33 Perini Rd, Elliot Lake, ON P5A 2T1  phone: (705) 461-3197 email: society4animals@bellnet.ca

 

Name

Address

Postal Code

Amp. Pledged

Amp. Collected

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INSTRUCTIONS FOR PARTICIPANTS

 TOTALS $    
 

1. IF PAYMENT IS MADE BY CHEQUE; MADE PAYABLE TO S.A.D.

 Participant's Name:  
 

2. CONTRIBUTIONS OF $10.00 OR MORE WILL AUTOMATICALLY BE RECEIPTED.

 Reg. #  
 

3. PLEASE ENSURE ADDRESS IS RECORDED, SO WE MAY FORWARD RECEIPTS

 Phone:  
  4. PLEASE ENSURE YOUR PLEDGE SHEETS ARE HANDED IN WITH YOUR FUNDS.    
  5. PLEASE HAVE PLEDGE SHEETS AND FUNDS TURNED IN BY OCTOBER 7th 2008