Pledge Form
LIONS OF MICHIGAN FOUNDATION EYE CARE, DO YOU? – PLEDGE FORM
5730 Executive Drive Lansing, MI 48911 517-887-6640 (Voice) 517-887-6642 (Fax) [email protected]
Hidden Lake Gardens – Tipton, MI Saturday, October 8, 2016 The charity I am running/walking for is ______________________________________. I understand that the donations I receive will be split equally (50% & 50%) between the Lions of Michigan Foundation and my designated charity, and if I do not designate a charity, all donations I receive will be retained by the Lions of Michigan Foundation for Project KidSight. Donor’s Name
Street Address
Total donations received: $_____________
City & Zip Code
Donation Amount
Amount enclosed: $_____________
Name: ____________________________ Phone: _________________ Email: __________________ Street Address: _______________________________ City/State/Zip: _________________________ _________________________ Team Name (If Applicable)
_________________________ Signature
__________________ Date
5730 Executive Drive Lansing, MI 48911 517-887-6640 (Voice) 517-887-6642 (Fax) [email protected]
Hidden Lake Gardens – Tipton, MI Saturday, October 8, 2016 The charity I am running/walking for is ______________________________________. I understand that the donations I receive will be split equally (50% & 50%) between the Lions of Michigan Foundation and my designated charity, and if I do not designate a charity, all donations I receive will be retained by the Lions of Michigan Foundation for Project KidSight. Donor’s Name
Street Address
Total donations received: $_____________
City & Zip Code
Donation Amount
Amount enclosed: $_____________
Name: ____________________________ Phone: _________________ Email: __________________ Street Address: _______________________________ City/State/Zip: _________________________ _________________________ Team Name (If Applicable)
_________________________ Signature
__________________ Date
