All proceeds benefit the

gospel ministry of
Gateway Pregnancy Center
Walk-a-thon Sponsor Pledge Form
Walker’s name
Street Address ________________________________________________Apt #_________________________________
Town: _____________________________State ______Zip ____________Church_______________________________
Telephone with area code: ( ) _______________________Church /youth group: ___________________________

Please print all information and circle pledge desired

Sponsor first name
Address
:( ) ________________________
Circle one $15 $20 $25 $50 $75 $100 $150 $200 other $ Paid
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 $15Total
$20 pledges
$25 $50 on$75this$100
sheet $ _____________
$150 $200 other $ __________________