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walk life - sponsor pledge form 1910 east bay dr, largo ......paid cash paid check paid online bill...

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  • Walk Life - Sponsor Pledge Form 1910 East Bay Dr, Largo ......Paid Cash Paid Check Paid Online Bill me later $25 50 $100 Other$_____ Phone: 727-216-1410 x 402 Fax: 727-216-1411 This
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Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communications) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ *A COPY OF THE REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE." Charitable Contribution Solicitation Registration: CH3281 Office Use Only: P T Walk For Life - Sponsor Pledge Form If "Bill Me Later", Address is Required Please Print Clearly Make Checks Payable To: Walk For Life 1910 East Bay Dr, Largo, FL 33771 • Walker's Name _______________________________ Address _________________________________ Phone_____________________ City ____________________ St _____ ZIP_________ E-mail ___________________________________ Team ___________________________________ Church/Org _____________________________ Your Fund-raising Goal: $________ 1: Total Pledged: $__________ 2: Total Paid: $___________ 3: Total Raised: (1+2): $___________ MAIL THIS PLEDGE FORM TO OUR LARGO OFFICE AT THE ADDRESS ABOVE BY WALK DAY (SATURDAY, MAY 9). Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communications) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communications) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communications) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communications) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communications) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communication) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communication) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communications) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communications) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communications) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communications) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communications) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communications) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communications) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Name _________________________________ Phone ____________________ Address __________________________________________________________ City _________________________________ State ______ ZIP_____________ E-mail ____________________________________________________________ (to opt-in to e-mail communications) ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $ 25 $ 50 $ 100 Other $_________ Phone: 727-216-1410 x 402 Fax: 727-216-1411 Need more info? Visit iwalkforlife.com for tips and FAQs or text "WFL" to 797979 (standard messaging rates apply) This is a single, tax-deductible donation - NOT a per-mile pledge.

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  • Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communications)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    *A COPY OF THE REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE." Charitable Contribution Solicitation Registration: CH3281 Office Use Only: P T

    Walk For Life - Sponsor Pledge Form

    If "Bill Me Later", Address is Required Please Print ClearlyMake Checks Payable To: Walk For Life

    1910 East Bay Dr, Largo, FL 33771 •

    Walker's Name _______________________________ Address _________________________________ Phone_____________________City ____________________ St _____ ZIP_________ E-mail ___________________________________Team ___________________________________ Church/Org _____________________________

    Your Fund-raising Goal: $________1: Total Pledged: $__________

    2: Total Paid: $___________ 3: Total Raised: (1+2): $___________

    MAIL THIS PLEDGE FORM TO OUR LARGO OFFICE AT THE ADDRESS ABOVE BY WALK DAY (SATURDAY, MAY 9).

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communications)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communications)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communications)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communications)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communications)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communication)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communication)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communications)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communications)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communications)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communications)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communications)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communications)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communications)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Name _________________________________ Phone ____________________Address __________________________________________________________City _________________________________ State ______ ZIP_____________E-mail ____________________________________________________________(to opt-in to e-mail communications)

    ■ Paid Cash ■ Paid Check ■ Paid Online ■ Bill me later $25 $50 $100 Other $_________

    Phone: 727-216-1410 x 402 Fax: 727-216-1411

    Need more info? Visit iwalkforlife.com for tips and FAQs or text "WFL" to 797979 (standard messaging rates apply)This is a single, tax-deductible donation - NOT a per-mile pledge.

  • Our Family DoctorsQuality healthcare from the heart!

    1910 East Bay DriveLargo, FL 33771727-216-1410 x 402

    2019 Walk For LifeTop 20 Churches

    Pastor Glenn & Elaine Davis . . . . . . . . . . $12,000Nancy Leef . . . . . . . . . . . . . . . . . . . . . . . $9,505McCormick Family . . . . . . . . . . . . . . . . . $8,823Mary McNichols . . . . . . . . . . . . . . . . . . . $7,590Peggy Johnson . . . . . . . . . . . . . . . . . . . . $7,383Kari Kee . . . . . . . . . . . . . . . . . . . . . . . . . . $6,750George Loeffler . . . . . . . . . . . . . . . . . . . . $6,312Barry & Peggy Wood . . . . . . . . . . . . . . . $6,224Jackie & Cadie May . . . . . . . . . . . . . . . . $6,200Verigan Family . . . . . . . . . . . . . . . . . . . . . $6,070Betty McLane . . . . . . . . . . . . . . . . . . . . . $6,000Rose Ouellette . . . . . . . . . . . . . . . . . . . . $5,851Mary Torcivia . . . . . . . . . . . . . . . . . . . . . . $5,577Terri Pitchon . . . . . . . . . . . . . . . . . . . . . . $5,300Sheri Nymark . . . . . . . . . . . . . . . . . . . . . $5,200Alivia Yorke . . . . . . . . . . . . . . . . . . . . . . . $5,125Mike Harley . . . . . . . . . . . . . . . . . . . . . . . $5,100Robert & Deidre Sorensen . . . . . . . . . . . $5,090David Berg . . . . . . . . . . . . . . . . . . . . . . . $5,065Martha Lyons . . . . . . . . . . . . . . . . . . . . . . $5,055

    “LIFESAVER DINNER CLUB”*2019 Top 20 Walkers

    United Methodist Church

    Indian Rocks Baptist Church . . . . . . . . . . $79,507Countryside Christian Church . . . . . . . . . $66,909Calvary Church - All Campuses . . . . . . . $39,373Starkey Road Baptist Church . . . . . . . . . $28,030Faith Fellowship of St Petersburg . . . . . $26,028Shoresh David Messianic Synagogue . . . $21,321Gulf Coast Community Church . . . . . . . . $20,554Clearwater Community Church . . . . . . . $17,840Harborside Christian Church . . . . . . . . . $15,410Abundant Life Ministries . . . . . . . . . . . . . $14,968Tampa Covenant Church . . . . . . . . . . . . $13,103New 2 U Thrift Store . . . . . . . . . . . . . . . $11,525Feather Sound Church . . . . . . . . . . . . . . $10,853Countryside Christian Academy . . . . . . . $10,791Central Christian Church St Petersburg . $10,491Seminole Assembly Ministries . . . . . . . . $10,020Our Savior Lutheran- All Campuses . . . . $9,910Grace Family Church- All Campuses . . . $7,755Calvary Chapel (St . Petersburg) . . . . . . . $7,498Christ Community PCA . . . . . . . . . . . . . . $6,960 *Join the Club by raising $1,500 or more

    Check-in begins at 8amWalk begins at 9am

    Rain or ShineSaturday, May 9th

    Contact us @

    or727-216-1410 x402

    A SPECIAL THANK YOU TO OUR CORPORATE SPONSORS!

    Medicare Plan Specialists


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