Donation Sheet

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Thank You for sponsoring me in Dr Patel’s Pound 4 Pound Challenge. My goal is to
lose weight and with your help raise money for a non-profit organization. Thanks for
your support, I look forward to the challenge ahead to improve my health and wellness.
My Name:___________________!
My Charity: ___________________________
My Start Date:________________!
My End Date: _________________________
My Weight Loss Goal: _________!
My Personal Contribution/Pound: __________
My Actual Weight Loss:__________
Name
Address
$/lb
Total
PAID
Total Donation Raised ($/pound x total weight loss)
Total Donation Raised ($/pound x total weight loss)
The Living Proof Institute | ADD MORE LIVE TO YOUR LIFE™
9277 Centre Pointe Drive | Suite 350 | West Chester | Ohio | 45069 | 513 785 0686

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