Pledge Form
I, _______________________________ agree that all monies collected from individuals
sponsoring my efforts in Locks of Love, will be donated to the American Cancer
Society. By signing this sheet I agree that the money collected and placed in this
envelope balances to the total amount written at the bottom of this form.
Name: _____________________________________________________________
Address: _____________________________________________________________
Phone: _____________________________________________________________
Email: _____________________________________________________________
NOTE: Please make checks payable to the Locks of Love.
Donor’s Name and Address Cash Collected Check Total
(If over $5 cash or $75 check, please get address info)
Totals