Donor Tracking Sheet
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1FREEZIN’ FOR A REASON
POLAR PLUNGE
For Charity
Donor Tracking Sheet
To Benefit Shriners Hospital for Children
Please make checks payable to: Cairo Shriners “Polar Plunge”
Name of Plunger _________________________________________________________________
Team Name (if applicable) __________________________________________________________
Sponsor Name
Address
Phone
Cash Amt
Chk Amt
1.)
2.)
3.)
4.)
5.)
6.)
7.)
8.)
9.)
10.)
11.)
12.)
13.)
14.)
15.)
16.)
17.)
18.)
19.)
20.)
Cash Total
Check Total
Please bring this completed form with you to the Plunge. It will be
Collected upon check in. If you would like to make a copy for your
TOTAL RAISED
records, please do so in advance.
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Parent category: Medical