CLEARFIELD-JEFFERSON COUNTIES
FIRST ANNUAL WALK FOR SUICIDE PREVENTION & AWARENESS
WALKER
PLEDGE	Name		Page__of__
FORM	Street
	City	State		Zip
	Tel. Work		Home
	Age
	DuBois Park
	Team Name
Signed X	Make Checks Payable to:
Parent/Guardian X	Clearfield Jefferson MH/MR Suicide Prevention Team
Pledge Name	Address		Donation	Collected
EXAMPLE:  Jane Smith	3rd Street, My Town, My State. 15801		$20.00	yes
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	TOTAL TURNED IN TODAY		$
	TOTAL TURNED IN PRIOR TO WALK		_________________________
	TOTAL RAISED		$
	T-shirt $10.00           Y / N		Size XS, S, M, L, XL, XXL
	Free T-shirt to those who collect $100.00 in pledges.
Instructions
Start now to get as many sponsors as you can.  There is no limit.  You can always get extra pledge forms
Be sure your sponsors understand the commitment to you & the Clearfield Jefferson Suicide Prevention Team
You are responsible for collecting all pledges.
Keep a copy for your records.
Thank you for helping save lives by preventing suicide in your counties.