1. technology and computing
2. consumer electronics
3. telephones
4. mobile phones

Saturday, April 25, 2015
Riverview Bandshell, 200 Riverview Dr., Clinton, IA
Registration: 8:15 am • Walk Begins: 9:00 am
It's Easy!
• Only a two mile walk – bring the whole family.
• Come rain or shine.
• Free T-shirt for $200 in pledges!
• Walk on your own if you can’t join us. (Please
mail or turn in your pledges before the walk.)
Step 1:
Register by email, by mail, by phone,
or with your group leader TODAY.
Step 2:
Ask EVERYONE you know to sponsor
you. You will be amazed how many will say YES!
Step 3: Please be sure all names and
addresses are complete and easy to read. Bring
your completed Pledge Form(s) the day of the Walk
(or walk on your own and mail it in).
Step 4: Collect pledges less than $20. We’ll
take care of the rest.
Questions?
563.242.6628 or
pregnancycenterclinton.org
Your support helps provide accurate information and
compassionate assistance to many women, men, and
students every year. We offer comprehensive, positive
alternatives to abortion.
Our free and confidential services include:
• Pregnancy Testing
• Confidential Peer Counseling
• Limited Obstetrical Ultrasounds
• Support for FamilyMembers
• Medical Referrals
• Accurate Information
• TREE 3 Incentive Program
• One-on-One Mentoring
• Bible Studies
• The Boutique - Clothing, Food, and Baby Items
• Sexual Health Education
• Post-Abortion Support
2015 Walk for Life
April 25 • Benefitting The Pregnancy Center
ST ____________ Zip _______________________________
q PAID q BILL ME
The Pregnancy Center
240 N. Bluff Blvd., Ste 105
Clinton, IA 52732
Questions?
Phone____________________________________________
Church/Group ______________________________________
563-232-6628
or pregnancycenterclinton.org
Email ____________________________________________
City
ST
Zip
Phone
Email
q $35
q $50
First
Last
Address
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q $25
q $35
q $50
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q $100 q Other $___________
q $35
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q $100 q Other $___________
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First
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q $100 q Other $___________
q $100 q Other $___________
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Address
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First
Address
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Phone
Email
q $25
q $35
q $50
q $100 q Other $___________
ST
Zip
Please fill out and return this form today so
Phone
we will know you’re coming!
Email
q $35
q $50
First
q $100 q Other $___________
Last
City
Walker’s Name_____________________
Address __________________________
Address
ST
Zip
City _____________________________
Phone
ST ______________ Zip _____________
Email
q $35
q $50
First
q $100 q Other $___________
Phone ____________________________
Last
Church/Group ______________________
Address
City
ST
Zip
Email ____________________________
Phone
I am :
Email
q $35
q $50
First
q $100 q Other $___________
Last
City
q Adult q Teen
Shirt Size needed (circle one):
Adult: S M L XL XXL
Address
ST
Zip
Phone
I release this organization from any liability
for this event.
Email
q $25
q $100 q Other $___________
Last
City
q $25
q $100 q Other $___________
Pre-Register Today!
Last
Address
q $25
q $100 q Other $___________
Last
First
q $25
q $100 q Other $___________
Address
q $25
q $100 q Other $___________
q $50
First
q $25
q $100 q Other $___________
Last
q $35
q PAID q BILL ME
ST
Phone
q $25
q $100 q Other $___________
Last
City
q $25
q $100 q Other $___________
Address
q $25
q PAID q BILL ME
Email
q $25
q $100 q Other $___________
Last
Phone
q $25
q $100 q Other $___________
Zip
Address
q PAID q BILL ME
Address
ST
Last
q PAID q BILL ME
Last
City
First
q PAID q BILL ME
First
q $100 q Other $___________
Address
q PAID q BILL ME
q $50
q PAID q BILL ME
q $35
Last
q PAID q BILL ME
Email
q PAID q BILL ME
q PAID q BILL ME
Zip
Phone
q $25
q PAID q BILL ME
ST
First
q PAID q BILL ME
City
q PAID q BILL ME
Address
q $25
q PAID q BILL ME
Last
q PAID q BILL ME
q PAID q BILL ME
First
q $35
q PAID q BILL ME
Email
q $25
Please print all information clearly. Make check payable to The Pregnancy Center.
Zip
Phone
q $25
City _____________________________________________
ST
q PAID q BILL ME
Address __________________________________________
City
q PAID q BILL ME
No need to collect money. We handle the billing
for anyone that is unable to pay at the time of their
pledge ($20 minimum for us to bill, please)!
Address
q PAID q BILL ME
Walker’s Name _____________________________________
Last
q PAID q BILL ME
q PAID q BILL ME
Bring this completed form to the walk. You may photocopy this form for additional pledge space or download a PDF from our website.
First
q $35
q $50
First
q $100 q Other $___________
Signature (parent, if minor):
________________________________
Last
Address
City
ST
Zip
I am unable to walk, but will make a
Phone
donation of $___ (Please make check
Email
payable to The Pregnancy Center).
q $25
q PAID q BILL ME
Sponsor Pledge Form
P L E A S E P R I N T C L E A R LY !
My Goal _____ Total Pledges ______
q $35
q $50
First
q $100 q Other $___________
Return this form to:
Last
The Pregnancy Center
Address
City
ST
Zip
Phone
240 N. Bluff Blvd., Ste 105
Clinton, IA 52732
Email
q $25
q $35
q $50
q $100 q Other $___________
©Keener Marketing, Inc. • 1-800-338-8928 • www.prcresources.com
Or pre-register by phone or by email.