Pledge Form 5th Annual Pigeon Lake Pedal Saturday

● Hand in Pledge Form on event day or send to Pigeon Lake Pedal, Alberta Cancer Foundation, 11560 University Ave, Edmonton, AB, T6G 1Z2.

¨ ● Tax receipts issued for donations of $15 or more or upon request. Complete name and address must be provided.

¨ ● Please submit pledge sheets and funds by the event date. Thank you for your generous support!

PLEDGED BY		COMPLETE ADDRESS/CITY		POSTAL CODE	$ PLEDGED	PAID
Sample: John Doe (Print clearly please)		123 Anywhere Street, Edmonton,Alberta		T1Y 2B3	200.00	Cheque
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All pledges collected on this page? Yes____No_____	Amount not collected: $_________		Total Collected		$
*Receive ONE entry into prize draw for every $100 in pledges COLLECTED by event.* *NEW!! FREE REGISTRATION with $500 in COLLECTED pledges(to ACF by June 29!)*