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(Please print this form and send to us with your donation)
YES! I am happy to participate and join prostate cancer survivors, their families, and
their friends in the Boston Prostate Cancer Walk on
Sunday, June 19, 2011 on the Boston Common
Registration 9:00-11:30 AM Pre walk Ceremony 11:30 AM Walk at 12:00 noon
Enclosed is my registration fee of $20, which includes a T-shirt which will be available on the day of the walk. All entries must be received by May 30, 2011 to guarantee a T-shirt. After June 3rd, registration fee will be $25.
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No. of walkers _____ at $20.00 each. After June 3rd, no. of walkers _____ at $25.00.
Number of T-shirts _____ Total enclosed $________
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| Name:_________________________________ T-shirt size: XXL XL L M |
| Address:_______________________________ City, State, Zip____________________ |
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| Name:_________________________________ T-shirt size: XXL XL L M |
| Address:_______________________________ City, State, Zip____________________ |
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| Name:_________________________________ T-shirt size: XXL XL L M |
| Address:_______________________________ City, State, Zip____________________ |
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| Name:_________________________________ T-shirt size: XXL XL L M |
| Address:_______________________________ City, State, Zip____________________ |
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I wish to make a monthly pledge of $ ________ through December 2011.
I am unable to participate in the Boston Prostate Cancer Walk. Enclosed is my tax exempt contribution of $25_____ $50_____ $100_____ Other $_____ for prostate cancer research.
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Boston Prostate Cancer Walk 2011 Individual Sponsorship Opportunities
NOTE: DEADLINE for brochure is April 30; deadline for program and T-shirt is May 30, 2011
$1000 Gold Sponsor-Individuals: Your name on T-shirt, Program, Brochure, website & fliers .
$500 Silver Sponsor-Individuals: Your name will be highlighted on Program, Brochure, website & fliers.
$250 Bronze Sponsor-Individuals: Your name on Program, Brochure, website & fliers.
*Names may be "In Honor Of" or "In Memory Of".
Please make checks payable to: Boston Prostate Cancer Walk
and mail to: 69 Farragut Avenue, Somerville, MA 02144
For more info, please contact Stan Klein at 617-625-4875 or email: klein@rcn.com.
Thank you for your support!.
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