3rd ANNUAL POLAR BEAR DIP

January 28,2017, 12 pm to 2:30 pm

Dallas Elks #71
8550 Lullwater Dr. Dallas, TX 75238-4753

PLEDGE FORM      Pledge raiser____ Plunger____

First Name: _____________________________________________

Last Name:______________________________________________

Address:________________________________________________

City:______________

State:_____________

Zip: ______________

Email: ______________________Phone:_______________ DOB:  /  /

 

All proceeds benefit the Dallas Elks #71 Community Services, Special Needs Children to participate in Elks Summer Camp and Pool Fund.

A minimum of $100 in donations needs to be collected for a free registration to the “First Dip” and Festivities that follow.

If you do not raise donations, you may join us for $20 donation.

(Lunch included).

Participants or group pledge raiser who raise donations totaling $600 and over, will receive our “Polar Bear Dip” t-shirt, plus the hamburger lunch afterwards.

 

If you are under 18, a waiver MUST be signed by a parent or guardian.

Please make checks payable to: Dallas Elks #71 with “Polar Bear Dip” in the memo section of check.

For more information and to pre-register, contact Steve Conway at elks71polardip@gmail.com or call 214-762-0031.

All proceeds benefit the Dallas Elks #71 Community Services, Special needs Children to participate in Elks Summer Camp and Pool Fund, specifically our services to Veterans programs, Austin Street Shelter and Youth Activities and your group gets 70% of the pledges. Plungers have 7 days after event to collect donations and turn into Dallas Elks #71 or Steve Conway.

 

Thank you for your generous support!

 

Group name _____________________  Designate Plunger ________________

Group Contact____________________        Phone Number___________________

Pledge Person____________________       Phone Number___________________

 

Person Pledging                        Address                              Phone            Pledge$

8/12/16