Walkathon to Benefit The Opening Word Program PledgeForm Name:_____________________________ Address:___________________________ Phone:_____________________________ Sponsor Amount 1._________________________________ 2.__________________________________ Saturday April 25, 2015 3.________________________________ 1 to 3 pm Rain or Shine 4.__________________________________ Queen of the Rosary Motherhouse 555 Albany Avenue, Amityville NY 7.__________________________________ 5.__________________________________ 6.__________________________________ 8.__________________________________ 9.__________________________________ Registration Form Name: ____________________________________________ Address:____________________________________________ Phone #____________________________________________ e-mail:______________________________________________ Registration Fee: Adults ~ $10.00 Children ~ $1.00 10._________________________________ Total:__________________ Pleasehaveyoursponsorsmake theircheckspayableto: TheOpeningWordProgram Waiver: I wave and release the coordinators of “Walk the Path for Literacy” from all claims and liabilities from my participation in this event. Signature:_____________________________________ Date:________________________ Mail this completed form and check payable to: The Opening Word Program 1434 Straight Path, Wyandanch, NY 11798. For additional information contact: Sister Lenore Toscano (631) 643-0541, opword2@yahoo.com Family Fun Clowns Face Painting and more…
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