Walk For Health

Donor's Name

Amount Recieved

1._________________________________________________

$___________________

2._________________________________________________

$___________________

3._________________________________________________

$___________________

4._________________________________________________

$___________________

5._________________________________________________

$___________________

6._________________________________________________

$___________________

7._________________________________________________

$___________________

8._________________________________________________

$___________________

9._________________________________________________

$___________________

10.________________________________________________

$___________________

11.________________________________________________

$___________________

12.________________________________________________

$___________________

13.________________________________________________

$___________________

14.________________________________________________

$___________________

15.________________________________________________

$___________________

* Donations will be accepted Walk Day at sign in
* All donations are tax-deductible - Gail Devers Foundation Inc.
* Donors requiring a receipt should make a written request or send an email to:

Gail Devers Foundation, Inc.
6555 Sugarloaf parkway
Suite 307 - 137
Duluth , Georgia 30097
770-822-4099
Walkforhealth@gaildeversfoundation.org

Make Checks or money orders payable to Gail Devers Foundation

Participants Name:	__________________________________________________________
Home Address:	___________________________________________________________
City:	__________ Zip: __________ State: __________
Daytime Phone:	____________________________
Evening Phone:	____________________________
Email:	___________________________________________________________