Name:
________________________

Company:
________________________

Address:
________________________

City:
________________________

State/Zip
_______________________

Phone:
________________________

E-Mail:
________________________

Tee-Shirt Size: (circle one)

Small    Medium   Large   X-large

This is a prepaid event. Collect money from sponsors before the event.  Ask sponsors for a $10 contribution.  Record each sponsor's name and donation.  Bring this form with you and the donations on August 28th.
 

	Sponsor's Name	Donation:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
	Company Matching Gift Donation:

                                                        Envelope Total:

For More Information Contact:

Blading for Paving
Larry Piegza
Tel: 716-879-6939
FAX: 716-879-6700
Internet: larry.piegza@outokumpu.com