All proceeds benefit the

gospel ministry of
Gateway Pregnancy Center

Walk-a-thon Sponsor Pledge Form

Walkers 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 $ _____________