Note:  Highlight only the form, print it, fill it out and send to the address on the bottom

"Ride for the Relay"
Sponsor Application 2011
Check all appropriate boxes below:
Motorcycle (  )     Auto (  )     Non-riding Sponsor (  )

Starting Point:_______________ Ending Point:_______________

Name:_______________________________________________

Corporation:___________________________________________

Address:______________________________________________

City/State/Zip Code:_____________________________________

Telephone:  (     ) ________________

eMail address:__________________________________________

Corporate Sponsor:   (   ) $600
       Pin Sponsor:   (   ) $300
                     Gold Sponsor:   (   ) $66 + $66 = $132
  Silver Sponsor:   (   ) $66
 Bronze Sponsor:   (   ) $33
   Rider Sponsor:   (   ) $33

Helper Sponsor:___ Prayer Sponsor:___

Special Donation $___________

Send all Sponsorships to:

"Ride for the Relay"
Rodger L. Fox
806 Hardin Avenue
Jacksonville, Illinois 62650

Make all Checks payable to:  Ride for the Relay