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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 Father's Day, June 21, 2009 on the Boston Common.
Registration 9:00-11:00 AM Pre walk Ceremony 11:00 AM Walk at 11:30 AM
Enclosed is my registration fee of $20, which includes a Tote Bag which will be available on the day of the walk This year, to better promote our walk and awareness of prostate cancer, walkers will receive a canvas Boston Prostate Cancer Walk Tote Bag with our logo and sponsors names. Please wear your T-shirt from any of our previous walks.
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| No. of walkers _____ Number of Tote Bags _____ Total enclosed $________ |
| Name:__________________________________________________________ |
| Address:________________________________________________________ |
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| Name:__________________________________________________________ |
| Address:________________________________________________________ |
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| Name:__________________________________________________________ |
| Address:________________________________________________________ |
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| Name:__________________________________________________________ |
| Address:________________________________________________________ |
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I wish to make a monthly pledge of $ ________ through December 2009.
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 2009 Individual Sponsorship Opportunities
Deadline for names to be placed on our canvas Tote Bag is June 1, 2009
$1000 Gold Sponsor-Individuals: Your name on Tote Bag, Walk Program & website.
$500 Silver Sponsor-Individuals: Your name on Walk Program & website.
$250 Bronze Sponsor-Individuals: Your name on Walk Program.
*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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