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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
				Total Pledge Money Collected				$
	This page can be duplicated
	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.