2003 Make-A-Wish Lake Placid Ironman Triathlon Sponsor Form

I would like to help you support the mission of the Make-A-Wish Foundation of Massachusetts!

__ 25 cents/mile = $35 __ 50 cents/mile = $70 __ $1/mile = $140

__ I will make a flat donation of $__________

__ Check - Please make payable to “Make-A-Wish Foundation of Massachusetts”

__ Credit card - Make-A-Wish Foundation - MC/VISA/Discover _______________________________

Expiration date ____________________________________________

Cardholder name __________________________________________

Signature _________________________________________________

Please fill out your information for my records:

Name __________________________________________________________________

Address _________________________________________________________________

City/State/Zip ____________________________________________________________

Daytime phone number _____________________________________________________

Please return this form to me at:

Paul McCarron

PO Box 55

West Roxbury, MA

02132