2002 CH.I.L.D. Squash Challenge

In Support of the CH.I.L.D Foundation

October 16-19, 2001 Co-Hosted by: Hollyburn Country Club and Evergreen Squash Club, West Vancouver, BC

For Pledge Info call Gary Bombay - 980-5538

Participant's Name:

E-mail:

Address:

Total Pledges $:

For Registration Info call Marvin Mizinski -

726-0805 or 988-1539

Daytime Phone # :

Evening Phone # :

PLEASE RETURN THE PLEDGE FORM AND PLEDGES TO THE REGISTRATION DESK

PLEDGES: INFORMATION TO BE INCLUDED ON TAX RECEIPT (PLEASE PRINT CLEARLY)

PLEDGE (Cheques to CH.I.L.D. Foundation)

_____ CASH

_____ CHQ

_____ VISA

_____ MC

_____ AMEX

RECEIPT TO (INDIVIDUAL OR COMPANY NAME)

MAILING ADDRESS

$ AMOUNT

CARD NUMBER

CITY

PROV

POSTAL CODE

PHONE

DATE RECEIVED

EXPIRY DATE

TAX RECEIPT #

_____ CASH

_____ CHQ

_____ VISA

_____ MC

_____ AMEX

RECEIPT TO (INDIVIDUAL OR COMPANY NAME)

MAILING ADDRESS

$ AMOUNT

CARD NUMBER

CITY

PROV

POSTAL CODE

PHONE

DATE RECEIVED

EXPIRY DATE

TAX RECEIPT #

_____ CASH

_____ CHQ

_____ VISA

_____ MC

_____ AMEX

RECEIPT TO (INDIVIDUAL OR COMPANY NAME)

MAILING ADDRESS

$ AMOUNT

CARD NUMBER

CITY

PROV

POSTAL CODE

PHONE

DATE RECEIVED

EXPIRY DATE

TAX RECEIPT #

_____ CASH

_____ CHQ

_____ VISA

_____ MC

_____ AMEX

RECEIPT TO (INDIVIDUAL OR COMPANY NAME)

MAILING ADDRESS

$ AMOUNT

CARD NUMBER

CITY

PROV

POSTAL CODE

PHONE

DATE RECEIVED

EXPIRY DATE

TAX RECEIPT #

_____ CASH

_____ CHQ

_____ VISA

_____ MC

_____ AMEX

RECEIPT TO (INDIVIDUAL OR COMPANY NAME)

MAILING ADDRESS

$ AMOUNT

CARD NUMBER

CITY

PROV

POSTAL CODE

PHONE

DATE RECEIVED

EXPIRY DATE

TAX RECEIPT #