Remember, you must contribute a minimum of $150 in order to participate.

Your Name:_____________________________________________________________
Team Name:___________________________________________________
Your address:________________________City:___________State:____Zip:________
Phone (day):___________________(evening):_______________

E-mail:_____________________________________________________

My goal is to raise:
___ $150 ___ $250     ___ $500   ___ $1,000       ___ $2,500
Your pledges directly support the MA Breast Cancer Coalition in its efforts to stop the breast cancer epidemic.
Please make checks payable to MA Breast Cancer Coalition - Contributions are tax-deductible - Please pre-pay

Don't forget to pledge yourself!

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