XVII
RIDER NAME
Do not add new pledges on sheets that have been previously submitted.
Use a new form each time you send in donations
You must make a copy of this sheet for your records
Send in Monthly
$500 of donations due by May 1, 2015
Full $1,500 of donations due by July 15, 2015
NAME/COMPANY
ADDRESS
Please return Monthly to:
American Cancer Society
Lehigh Valley Unit
3893 Adler Place, Suite 170
Bethlehem, PA 18017
ATTN: PPRAC
Phone: 610-921-2329 x3109 | Fax: 610-882-5861
ACS USE ONLY
Date Received
PLEDGES
PHONE # AMOUNT PAID PRIZES TO BE AWARDED
TOTAL FOR THIS SHEET
$
Total $ Received
Initials
AWARD
DECLINED
XVII
PLEDGE LEVELS, PRIZES AND AWARDS
(Individual & Business Contributors)
$50 to $99.............. PPRAC Pen
$100 to $249 ......... PPRAC Bottle Opener
$250 to $499 ......... PPRAC Pint Glass
Gold Sponsor
$500 to $999 ......... Commemorative Plaque
Listing on PPRAC website
PPRAC Pen, Bottle Opener & Pint Glass
Principal Sponsor
$1000 ..................... Name on Rider Jersey
Commemorative Plaque
Recognition PPRAC website
PPRAC Pen, Bottle Opener & Pint Glass
August 2–8, 2015
Syracuse, NY to
Palmerton, Pennsylvania
6 Days & 500 Miles
In kind Sponsor: Wte are always looking for donations of
materials or services that can be used during PPRAC.
It’s good practice to send in money on a regular basis—when
doing so, be sure to attach it to this completed form, make
a copy for your records, and mail this form to the:
American Cancer Society
Lehigh Valley Unit
3893 Adler Place, Suite 170
Bethlehem, PA 18017
Attn: PPRAC
www.pprac.net
We ride to support: