Pledge Form

Pledge Form

Saturday, April 19th, 2014

First Name:________________________________________

Last Name:___________________________________

Dear Potential Sponsor,

I am participating in the Shriner 5K Run/Walk. All proceeds will go to the Shriners Hospital for Children in Tampa, Fl. You can sponsor me for any amount that you are willing to contribute. Make checks to Shriners Hospital for Children. All contributions are tax-deductible; full address MUST be provided.

Thank you!

Name of Sponsor Pledge Amount Address
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Participants: Mail to: Jensen Beach High School, Attn. Key Club

2875 Northwest Goldenrod Road, Jensen Beach, FL 34957

Forms sent by mail are due by April 18th . If you have any questions please contact us at shriners5k@gmail.com