Alaska Team ADA

Pennock Island Challenge

Sponsorship

Our Mission: To prevent and cure diabetes and to improve the lives of all people affected by diabetes.

Pennock Island Challenge August 4, 2013

SPONSORSHIP/DONATION CONFIRMATION

Company Name: __________________

Telephone: ( _) ______________

Address: ____________________________________________________________________

Authorizing Name (Print): _________________________________________

Authorizing Signature: Date: _____________________

Title: ______________________________________________________________________

The above named individual or company wishes to support the Pennock Island Challenge in

Ketchikan Alaska August 4, 2013 with an honorary donation of: ____________________________

Your contribution supports diabetes research and education.

Please send this confirmation form as soon as possible using the address or email below.

Mailing Address:

(Make check payable to the American Diabetes Association/Pennock island challenge)

Attn: William Schulz

Team ADA

5940 Three C Lane

Ketchikan, Alaska 99901

E-mail: pennochchallenge@hotmail.com

907-247-5283

907-821-0860

American Diabetes Association is a

501c3 non-profit organization, established in 1940. TaxID #13-1623888

Our Mission: To prevent and cure diabetes and to improve the lives of all people affected by diabetes