The MARC Foundation
for the benefit of
Mid Hudson Addiction Recovery Centers, Inc.

Walk for Recovery

Saturday - September 17, 2011 - 10:00 AM

Prefix:
First Name: *
Last Name: *
Phone Number: *
E-mail Address: *
Street Address: *
Address Line 2:
City: *
State: *
Postal Code: *
Age if under 18:

Suggested Contributions: When making a donation please indicate on the Donation site under Special Instructions WALK FOR RECOVERY *
$25.00 Walker $50.00 Walker/Patron $75.00 Walker/Patron Angel $100.00 Walker/Patron Saint $1000.00 Event Marquee Sponsor $100.00 Mileage Marker Sign Sponsor $500.00 T-Shirt Sponsor Other Amount
Other Amount $
Program Booklet Ad:
$200.00 Full Page $150.00 Half Page $100.00 Quarter Page $75.00 Business card
Attach a File (For ads, Please upload camera ready art or send business card by September 2):
Business Sponsor Name:

Sponsor Street Address:

City:
State:
Zip Code:
Phone:
E-mail:
Donation:
Grand Total Donation:
Other Comments


* Required

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