THE ARC MERCER 2011 WALK-A-THON

REGISTRATION FORM/ DONATION SHEET

All early registration forms must be turned in by May 7, 2011.
Saturday, May 21, 2011 · Veterans Park · Kuser Road Entrance · Hamilton, N
Registration beings at 9 a.m. · Walk begins at 10 a.m. Picnic Lunch, DJ & Games to Immediately Follow
For more information, Contact: Kelly Jiras, Arc Mercer, at 609-406-0181 X146 or KJiras@arcmercer.org
All proceeds from the Walk-a-thon will benefit individuals with developmental disabilities in Mercer County.
Team Name: _________________________________________ Team Captain/Contact: _____________________________________

Your Name:_______________________________ Phone:_______________ Email:______________________ T-Shirt Size:____________

Sponsor Name Street, City, State Zip Email Phone Pledge Amount Paid/Method
Example: John Doe 180 Ewingville Rd. Ew- jdoe@arcmercer.org 609-406-0181 $10.00 Paid/Cash
ing, NJ 08638

Matching gifts welcomed! Please check with your place of employment. Total Amount Collected $_______________
All Participants raising at least $25.00 will receive a 2011 Walk-A-Thon t-shirt! Please make checks payable to The Arc Mercer.