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Grumpy Plunge

Saturday, February 27, 2010 

1:30 p.m. Registration/Check-In
3:00 p.m. Plunge
Followed by awards and prizes

Slippery's Bar and Grill
10 Church Avenue
Wabasha, Minnesota

Registration Form PDF (280k)

Great River Homes Website
Registration Form
* Plunger Name:
Home Phone:
Cell Phone:
* Address:
 * City:
 * State:
 * Zip:
 * E-mail:
I am registering as: Individual
  Member of Team (maximum of 8 people) Each plunger must complete a form .
 
Team Name: (if applicable)
Is your team part of an organization (company, civic club, student organization, church group, law enforcement agency, etc.) ?
Please indicate:
Payment Info
Payment Type: Check/Cash PayPal
 

Please make checks payable to
Great River Homes, Inc.

If choosing to pay by credit card, you will be directed to a PayPal link when you have successfully submitted this form.
My Shirt Size (checkone)
Extra Small Small Medium Large Extra Large
2XL 3XL      
Pledges
Name 1: Amount:
Name 2: Amount:
Name 3: Amount:
Name 4: Amount:
Name 5: Amount:
Name 6: Amount:
Name 7: Amount:
Name 8: Amount:
Name 9: Amount:
Name 10: Amount:
Name 11: Amount:
Name 12: Amount:
Name 13: Amount:
Name 14: Amount:
Name 15: Amount:
Name 16: Amount:
Name 17: Amount:
Name 18: Amount:
    Total:
 

Be sure to raise the minimum amount of $75
for the privilege to plunge!

 
Please enter the letters and numbers that appear above. This is to prevent spam.


 

 

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