Supporting THE HOSPICE OF LONDON with your pledges!			(For Office Use Only)
Name of Runner/Walker:
Address:
Phone Number:		Postal Code:
Sponsor's Name	Sponsor's Address	Sponsor's Phone Number	Amount Pledged	Receipt (y/n)
1.	.	.	.	.
2.	.	.	.	.
3.	.	.	.	.
4.	.	.	.	.
5.	.	.	.	.
6.	.	.	.	.
7.	.	.	.	.
8.	.	.	.	.
9.	.	.	.	.
10.	.	.	.	.
11.	.	.	.	.
12.	.	.	.	.
13.	.	.	.	.
14.	.	.	.	.
15.	.	.	.	.
16.	.	.	.	.
17.
18.	.	.	.	.
19.	.	.	.	.
20.	.	.	.	.
Please make cheques payable to; The Hospice of London. TOTAL PLEDGED                            Receipts for income tax purposes are issued  for pledges of $10.00 or more. TOTAL REMITTED

Instructions: In order to be eligible for great prizes, please complete your pledge form and collect the money before Race Day.  Bring both the completed form and all pledge money to the Pledge Table by 8:30am on Race Day.