4th Annual Hazel’s Hope 5K Fun Run/10K Trail Run/1K Walk -Official Pledge Form
| First Name | Last Name | Mailing Address (include apartment / suite) City, Province, Postal Code) | Cash | Cheque | Receipt Req’d |
Amount Pledged |
Amount Collected |
| John | Smith | 55 Any Street, Apt. 5 Mississauga, ON L5M 3M5 | √ | $20.00 | $20.00 | ||
Total number of pledge pages attached Total (this page only) |
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