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Please Print This Donor Form

Name ___________________________________________________		 Sole Burner 2003
Address__________________________________________________
City_____________________________State_____ Zip____________
Daytime Phone Number_____________________________________________
Team Name Ross Romenesko Team
Check if participating in AAL/LB Kid's Run box.gif (88 bytes)
  
Your efforts make a difference.  By collecting donations, you can help us reach our goal of $75 per person.  Checks should be made payable to the American Cancer Society.  All contributions are tax deductible.
CONTRIBUTOR'S NAME                  ADDRESS   CITY/ZIP   TELEPHONE      AMOUNT  
   Example: J. Smith    123 First Avenue        Anywhere, WI 54321        (123) 456-7890       25.00   
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         

TOTAL

 
   
Please feel free to duplicate this form
   
   
FOR OFFICE USE ONLY:
Amount in $ ____________________
Matching Funds $ ________________
  

MAIL TO: The Ross Romenesko Team,
3801 W. Spencer St.
Appleton, WI 54914
920-731-7161