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Swimmer Name:Age:
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Address:City:Zip:
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Cell (Parent)Email:
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Total Laps :
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Pledges Choose One:
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Sponsor Name
Email (for a thank you and tax recognition)Phone$_____ Per 25M lengthFixed AmountMatching Corporate FundsTotal PledgedAmount Enclosed
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Pledges can also be made at: GiveButter.com:TOTAL:
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By participating in the Active Against ALS Swimathon, I, for myself, my executors, administrators and assigns, do hereby release and discharge Active Against ALS and all sponsoring businesses and organizations and their agents from all claims of  damages, demands, actions and causes of actions whatsoever, in any manner  Please make checks payable to: Active Against ALS. Memo: Swimathon
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Signature______________________________________ (Parents signature if under 18)
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Questions? Contact Anne Steinhauer at Active Against ALSSteinhaueraaals@gmail.com or 734-476-6499
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