PARTICIPANT COLLECTION INFORMATION

Please make checks payable to The Tommy Fund.  Bring your contributions with this form to The Tommy Fund 2012 Family Day and drop them off at registration. Thank you for your contribution! Your support will make a difference in the life of a child!

Name: ______________________________ Phone: ____________________

Email Address: ________________________________________

Donor Name

Address

Email Address

Contribution Collected

Our goal is for each fundraising participant to raise a minimum of $100. Online fund raising can be done at www.tommyfund.org

Each participant who raises $100 or more receives a complimentary entry.