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THE
THIRD ANNUAL
GIFT
OF LIFE
1000
MILE WALK-RUN
Starting
from Evanston, Illinois on September 11, 2001
Finishing
on Long Island, New York on September 30, 2001
Registration Form
Name____________________________ Age____ Phone_____________________
Street__________________________ City___________State____Zip___________
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Sponsors Name |
Phone |
Pledge $ per mile |
Total Pledge $ |
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1 |
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2 |
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3 |
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4 |
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5 |
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6 |
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7 |
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8 |
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9 |
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10 |
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11 |
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12 |
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13 |
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14 |
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15 |
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Payment
options for pledges and donations |
Total Miles: |
_______ |
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Make
checks payable to the following organizations |
Grand
Total of Pledge: |
$______ |
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Gift Of Life, Inc. |
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Rotary District #______ |
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Local Rotary Club |
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Please, print
this form and fax to (516) 504 - 0828 |
