Running To Grant A Child’s Wish

RUNNER’S NAME:  Robert Coleman

Your Name:

Address:

Phone Number:

Email Address:

Pledge Amount:

Visa __   MC ___ AMEX___  Discover___

Card#_________________________________

Exp. Date:______________________________

Signature:_______________________________

Mail, fax or email the form to:

Make-A-Wish Foundation

7951 East Maplewood Ave. suite 126

Greenwood Village CO 80111

FAX: 303-755-3108

Email: jmazak@colorado.wish.org

100% of all donations go directly to the Make a Wish Foundation.

Thank you for your support!