Name Address City/Province Postal Code Phone Donation Number Ex. Johnathan Doe 999 Any Street X2X 2X2 416-555-1234 $25.00 1. 2. 3. 4. 5. 6. 7 8. 9. 10. PLEASE PRINT Total Lupus Grand Prix Please Make Cheques Payable To: – All donations of $20.00 and higher will receive tax receipts. PLEASE DO NOT INCLUDE TEAM ENTRY FEES ON THIS FORM
Name Address City/Province Postal Code Phone Number Donation Ex. Johnathan Doe 999 Any Street X2X 2X2 416-555-1234 $25.00 1. 2. 3. 4. 5. 6. 7 8. 9. 10. PLEASE PRINT Total Please Make Cheques Payable To: – Lupus Grand Prix All donations of $20.00 and higher will receive tax receipts. PLEASE DO NOT INCLUDE TEAM ENTRY FEES ON THIS FORM
Pledge-Form-for-GP-Race-2016.docx