MY SPONSORS

First name ________________________________________Last name_________________________________________________

Address ________________________________________Apt._________ City ________________State ________Zip___________
Circle one

$15

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$200

(other) $____________

First name ________________________________________Last name_________________________________________________

Address ________________________________________Apt._________ City ________________State ________Zip___________
Circle one

$15

$20

$25

$50

$75

$100

$150

$200

(other) $____________

First name ________________________________________Last name_________________________________________________

Address ________________________________________Apt._________ City ________________State ________Zip___________
Circle one

$15

$20

$25

$50

$75

$100

$150

$200

(other) $____________

First name ________________________________________Last name_________________________________________________

Address ________________________________________Apt._________ City ________________State ________Zip___________
Circle one

$15

$20

$25

$50

$75

$100

$150

$200

(other) $____________

First name ________________________________________Last name_________________________________________________

Address ________________________________________Apt._________ City ________________State ________Zip___________
Circle one

$15

$20

$25

$50

$75

$100

$150

$200

Total on both sides of this page = $____________ I am eligible for this prize: (circle one)

(other) $____________

Tote bag $150

Gift card $300
Dinner for two $750
Gift certificates to local retailer $1,000 Apple IPad mini $3,000
SPECIAL PRIZE $5,000
Other high sponsorships: Two Tickets to Sight and Sound, sports and electronic equipment much more!

Costco or Shoprite gift card $500

Help us reach our goal of $25,000 to help the work of Gateway Pregnancy Center!