Pledge Sheet to use if raising money for Friends of the Pinery Park

100 dollars raised = free race entry

Pledge Form: Please print clearly. Your sponsors name and address must be clearly printed as this information is used to issue Tax Receipts.

Office use only

Name of Runner/Walker:

Address:

Phone Number:

Postal Code:

Sponsor's Name

Sponsor's Address

Sponsor's Phone Number

Amount Pledged

Receipt (y/n)

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Please make cheques payable to: Pinery Provincial Park Road Race	TOTAL PLEDGED
Receipts for income tax purposes are issued for pledges of $20.00 or more.	TOTAL REMITTED