Our Mission: To prevent and cure diabetes and to improve the lives of all people affected by diabetes.
Pennock Island Challenge August 4, 2013
Company Name: __________________
Telephone: ( _) ______________
Authorizing Name (Print): _________________________________________
Authorizing Signature: Date: _____________________
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.
(Make check payable to the American Diabetes Association/Pennock island challenge)
Attn: William Schulz
5940 Three C Lane
Ketchikan, Alaska 99901
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