Autism Swimmathon Pledge Form

When asking for donations, please inform individuals that a flat donation will be collected at the
time they pledge while donations per lap will be collected at a later date once the number of laps
completed is recorded. Receipts for tax deductions are automatically given by the Autism Society for
donations.

This Pledge Form belongs to __________________________________________________________

(print swimmer’s name)

Number of laps completed _____________ Official Signature _______________________________

(Please have a volunteer sign to validate)

Street Address and Single Donation Per Final

Full Name City Postal Code Donation Lap Donation

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 Street Address and Single Donation Per Final
Full Name City Postal Code Donation Lap Donation

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Drop Locations
When you have collected all donations including “per-lap” donations, please drop off the money/checks
and pledge form at one of the drop locations listed on www.2010autismswim.blogspot.com no later than
July 31.