Home 12th Annual Make-A-Wish® Convoy
Saturday, Sept. 10, 2011
Leightys Flea Market
Bring this form with your collected donations to registration on the day of the Convoy.  All checks should be made out to "Make-A-Wish Truck Convoy".
Trucking Company  
Driver Name  
Home Address  
Phone  
E-Mail  
In order to be considered in leading the convoy, ALL monies must be turned in with this Pledge Form before the convoy starts.
I will help make a Wish come true with my pledge Address / Phone Number Amount Pledged/Paid
Name
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Total Pledge Money Collected $
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A copy of the official registration and financial information may be obtained from the Pennsylvania Department of State by
calling toll-free within Pennsylvania, 1-800-732-0999.  Registration does not imply endorsement.