Massachusetts Lions Eye Research District 33S Family Fun Day / Walk A Long October 2, 2004

Name of Lions Club	.
Your club or organization	.
Participants Name	.
Participants Street Address	.
City	state	zip
Participants Phone No.	day	night

Journey for Sight District 33S Pledge Sheet
Scusset Beach, Cape Cod , MA

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ALL DONATIONS ARE TAX DEDUDTABLE If additional sheets are needed please make copies and attach

TOTAL PLEDGE $     TOTAL PAID $ BALANCE DUE $

        Please bring all pledge sheets with monies collected to the Walk-A-Long. Make all checks payable to District 33S, Journey for Sight. Any questions call Gary Saccocia 508-378-7173. Any participants that turning in $100.00 or more the day of the Walk-A-Long will receive a T-shirt .
        After October 2 send all Monies to: Ray Hebert, 56 Page Road, North Attleboro, MA. 02760 (508)-699-3883. .

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TOTALS BROUGHT FORWARD FROM FRONT SHEET				.	.	.

ALL DONATIONS ARE TAX DEDUDTABLE If additional sheets are needed please make copies and attach

TOTAL PLEDGE $     TOTAL PAID $ BALANCE DUE $