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WALK MS: CONTRIBUTION SHEET

My fundraising goal is $______________________________________________________________________________________________________________________________
Participant Name ____________________________________________________________________________________________________________________________________
Address________________________________________________________________ City _________________________________ State_______ Zip_________________
Phone__________________________________________________________________ E-mail _____________________________________________________________________
Team Name __________________________________________________________________________________________________________________________________________
I’m walking in (event location)________________________________________________________________________________________________________________________

FUNDRAISER
This form is to help you keep track of the contributions you collect and is an easy way to keep a list of your donors all in one place. We do not require
you to complete this and turn it in. If you prefer to submit this form with your donations, you may do so. Don’t forget - you may be able to increase
your donation through your employer’s Matching Gifts. Visit MSohiowalk.org or call 216-503-4183 for more information on Matching Gifts.
Mail donations to: Walk MS | National MS Society | 6155 Rockside Rd., Suite 202 | Independence, OH 44131

DONOR
All donations are tax deductible to the maximum extent allowed by law. Canceled checks are sufficient IRS proof for donations less than $250. For
donations over $250 a tax receipt will be mailed to the donor in January 2016. Please make checks payable to ‘National MS Society’ and include the
participant’s name and Walk MS site in the memo section of each check.
Any questions please call: 216-503-4183

DONATION

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Total Deposit: _______________________________________________________________________________________________________________________________________