PARKINSON'S POWER ACROSS AMERICA '99 DONATION FORM

Yes! Count Me In For PPAA/'99

Name:       
Address:   
Address2: 
City:  State:  Zip: 
Telephone:  -  - 

I Wish to Designate My Pledge As Follows:

Team #1 - Matt's Trek from East to West
Team #2 - Donna's Challenge from West to East
Team #3 -  Kent's Adventure from Canada to Mexico
They're All Great! I can't decide. I dedicate my pledge to all of them!
Please send me details of the route, schedule (as available) and
                local celebratory events for the team(s) I have chosen.
 

Here's How Much I Wish to Pledge:

I pledge the following amount per mile (assumes average trek length of 3,000 miles):

a dollar per mile (total pledge: $3,000)
a quarter per mile (total pledge: $750)
a dime per mile (total pledge: $300)
a nickel per mile (total pledge: $150)
a penny per mile (total pledge: $30)
other (indicate: amount per mile: $. total pledge: $.00)

Contributions are tax deductible.

 

 

1. Make your check out to "PUW"  (Parkinson's Unity Walk).

2. Please write "PPAA"  (Parkinson's Power Across America) in the memo section of your check.

3. Mail both form and check to:
 
 

Robin Anthony Elliott
Executive Director
Parkinson's Disease Foundation
650 West 168th Street
New York, New York 10032-9982
1-800-457-6676 or 212-923-4778

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