Onward Upward Online Pledge Form

Instructions:

1. Enter & Submit Information and Donation Amount (No money due at this time)

2. A bill will be sent to your Mailing Address around April/May 2009. The bill will come from Penn State, and will include all appropriate tax information for a 2009 tax year deduction. No credit card information is needed and no payment will be due until time of billing.

All proceeds go to the Penn State Dance Marathon, which benefits children with cancer and research at the Hershey Medical Center. Additional information can be found at http://www.thon.org

First Name:
Last Name:
Email Address:
Mailing Address Street:
Mailing Address Street 2
City
State:
Zip Code
Please select the team that you are pledging on behalf of:	No Team (General Donation) Air Gordon Team: Adam Bain Church & Dwight Team: Craig Davis DU Dynasty: Matt Muldoon/Kahlil Williams Head Bandits: Jordan Rambo JD Parker Team: JD Parker KA Young Bucks: Jared Newman/Nate Gentzel New York City Team: Joe Hoelscher Pi Kap Alum: Jeff Martini Rite Aid Raptors: Jason Reed Sterling Limo: Johnny Donohoe Swooping Waltons: Mike Raak Synerfac Recruits: Adam Mills
Pledge Amount:	$5 $10 $25 $50 $100 $125 $150 $200 $250 $500 $750 $1000
Upon successful submission of this form, I understand that I will receive a bill from Penn State University in the April/May Timeframe.