All proceeds benefit the

gospel ministry of
Gateway Pregnancy Center
Walk-a-thon Sponsor Pledge Form
Walker’s name (first) _______________________________(last)_____________________________________________
Address: __________________________________________________________________________________________
Town: _____________________________State ______Zip ____________Church_______________________________
Telephone with area code: ( ) _______________________Church /youth group: ___________________________

Please print all information and circle pledge desired

Sponsor first name ________________________Sponsor last name __________________________________________

Address _________________________________________________ Apt# ______
City _____________________________State____ Zip____________ Telephone: ( ) ________________________
Circle one $15 $20 $25 $50 $75 $100 $150 $200 other $ __________________
Sponsor first name ________________________Sponsor last name __________________________________________
Address _________________________________________________ Apt# ______
City _____________________________State____ Zip____________ Telephone: ( ) ________________________
Circle one $15 $20 $25 $50 $75 $100 $150 $200 other $ __________________

Sponsor first name ________________________Sponsor last name __________________________________________

Address _________________________________________________ Apt# ______
City _____________________________State____ Zip____________ Telephone: ( ) ________________________
Circle one $15 $20 $25 $50 $75 $100 $150 $200 other $ __________________

Sponsor first name ________________________Sponsor last name __________________________________________

Address _________________________________________________ Apt# ______
City _____________________________State____ Zip____________ Telephone: ( ) ________________________
Circle one $15 $20 $25 $50 $75 $100 $150 $200 other $ __________________

Sponsor first name ________________________Sponsor last name __________________________________________

Address _________________________________________________ Apt# ______
City _____________________________State____ Zip____________ Telephone: ( ) ________________________
Circle one $15 $20 $25 $50 $75 $100 $150 $200 other $ __________________

Sponsor first name ________________________Sponsor last name __________________________________________

Address _________________________________________________ Apt# ______
City _____________________________State____ Zip____________ Telephone: ( ) ________________________
Circle one $15 $20 $25 $50 $75 $100 $150 $200 other $ __________________

Sponsor first name ________________________Sponsor last name __________________________________________

Address _________________________________________________ Apt# ______
City _____________________________State____ Zip____________ Telephone: ( ) ________________________
Circle one $15 $20 $25 $50 $75 $100 $150 $200 other $ __________________

Sponsor first name ________________________Sponsor last name __________________________________________

Address _________________________________________________ Apt# ______
City _____________________________State____ Zip____________ Telephone: ( ) ________________________
Circle one $15 $20 $25 $50 $75 $100 $150 $200 other $ __________________

Total pledges on this sheet $ _____________