3rd ANNUAL POLAR BEAR DIP
January 28,2017, 12 pm to 2:30 pm
8550 Lullwater Dr. Dallas, TX 75238-4753
PLEDGE FORM Pledge raiser____ Plunger____
First Name: _____________________________________________
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.
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.
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