Walkathon to Benefit The Opening Word Program

Walkathon to Benefit
The Opening Word Program
PledgeForm
Name:_____________________________
Address:___________________________
Phone:_____________________________
Sponsor Amount
1._________________________________
2.__________________________________
Saturday April 25, 2015
3.________________________________
1 to 3 pm
Rain or Shine
4.__________________________________
Queen of the Rosary Motherhouse
555 Albany Avenue, Amityville NY
7.__________________________________
5.__________________________________
6.__________________________________
8.__________________________________
9.__________________________________
Registration Form
Name: ____________________________________________
Address:____________________________________________
Phone #____________________________________________
e-mail:______________________________________________
Registration Fee:
Adults ~ $10.00
Children ~ $1.00
10._________________________________
Total:__________________
Pleasehaveyoursponsorsmake
theircheckspayableto:
TheOpeningWordProgram
Waiver: I wave and release the coordinators of “Walk the Path for Literacy”
from all claims and liabilities from my participation in this event.
Signature:_____________________________________
Date:________________________
Mail this completed form and check payable to: The Opening Word Program
1434 Straight Path, Wyandanch, NY 11798.
For additional information contact: Sister Lenore Toscano (631) 643-0541,
[email protected]
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