Official Sponsor Form

Yes! I want to make sure Jack suffers through the Suzuki Rock 'n' Roll Marathon and at the same time I want to support the efforts of the Leukemia and Lymphoma Society!

Here is my contribution to help Jack meet his outrageous goal of raising $10,000 for this worthy cause.

(Please circle the appropriate contribution level below)

$26.20            "Jack's gonna run a marathon? No way." level, "AKA $1/Mile Level"

$50                 "I'd have to see it to believe it" level

$100               "Maybe if he trains hard he can do it" level

$500               "With a little luck, he could possibly finish" level

$1000             "Jack can do anything he sets his mind to" level

$5000             "Jack will win his age group!" level

$10000           "Jack will carry you piggy-back for 26 miles" level

$_____           Make up your own level!

Please make checks payable to The Leukemia and Lymphoma Society and mail it to me along with this form as soon as you can.

                        Your contribution is 100% tax deductible.

Name:____________________________

Address:__________________________

City, State, Zip:_____________________

Email:____________________________

(I will email a photo of me at the finish line, suitable for framing!)

If you would like to make your contribution via credit card:

MC/Visa/American Express #_______________________________

Name on Card:_________________________Exp. Date:_________

Signature:______________________________________________