1. 2010 Polar Plunge Donation Tracking Form
Name :
Team Name :
Plunge Location :
Check or
Donor's Name Address City State ZIP Phone Number Amount Cash Paid
Return this form, with all collected donations, at your Plunge event registration.
Subtotal $ Please make all checks payable to Special Olympics Illinois.
Online Total (print your Firstgiving
webpage donations and attach to If donations are received after the Plunge, please mail to: Special Olympics Illinois, Attn: Polar Plunge, 605 E.
this form) $ Willow, Normal, IL 61761
Total Enclosed $