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

* 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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