POMFRET HUNTER PACE
October 7, 2012
Pace for a Purpose Pledge Form:
All proceeds to benefit the
DAY KIMBALL HEALTHCARE
Deary Memorial Cancer Fund
Make checks payable to: Pace for a Purpose and mail to
106 Liberty Highway, Putnam, CT 06260
Rider’s Name____________________________________________________________________
Address___________________________________________________________________
Phone_________________________ Email______________________________________
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Total Amount: |
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Signature___________________________________________ Date_________________
