Lymphoma Awareness Burpee Challenge Pledge Form
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1Lymphoma Awareness
Burpee Challenge
Pledge Form
Participants Name:____________________
Total Burpees Comlpeted:_______
Sponsor Name:______________________
Phone #: _________________
Amount Donated per Burpee: $________
Flat Rate Donation: $_________
Sponsor Name:______________________
Phone #: _________________
Amount Donated per Burpee: $________
Flat Rate Donation: $_________
Sponsor Name:______________________
Phone #: _________________
Amount Donated per Burpee: $________
Flat Rate Donation: $_________
Sponsor Name:______________________
Phone #: _________________
Amount Donated per Burpee: $________
Flat Rate Donation: $_________
Sponsor Name:______________________
Phone #: _________________
Amount Donated per Burpee: $________
Flat Rate Donation: $_________
Sponsor Name:______________________
Phone #: _________________
Amount Donated per Burpee: $________
Flat Rate Donation: $_________
Sponsor Name:______________________
Phone #: _________________
Amount Donated per Burpee: $________
Flat Rate Donation: $_________
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