Heroes Run Sponsorship Form

Your Name

First

Middle

Last

Your Contact Information

Company

Phone

Address

City

State

ZIP Code

Recognition

Please provide the exact name or how you would like to be recognized as a sponsor on the T-shirt and other sponsorship materials.

Donation Method

Preferred Donation Method

Invoice

Check

Credit/Debit Card

Invoice Amount

Platinum ($1000)

Gold ($500)

Silver ($250)

Bronze ($100)

Other…

Check Donation

Check Amount

Platinum ($1000)

Gold ($500)

Silver ($250)

Bronze ($100)

Other…

Make checks payable to United Way of the Blue Mountains. Please give the check to your Campaign Coordinator within 24 hours of this pledge.

Credit/Debit Card Donation

Credit Card Amount

Platinum ($1000)

Gold ($500)

Silver ($250)

Bronze ($100)

Other…

After completing this form you will be redirected to our payment page where you will be able to process your transaction in a secured environment. Please be sure to enter the same values that you have entered on this form. Thank you!

Total Annual Contribution

TOTAL: $0

Agreement

My signature below, confirms my pledge as stated above.

Signature

Security Question: What color is the sky?