Pledge Form

Please print this form and return it to the address listed at the bottom
Sponsor Pledge Sheet - 2004 Team IRA Sponsor Pledge Sheet

___________________________________________________________________
RUNNERS NAME

The ING New York City Marathon – Sunday November 7, 2004 Date: ________________

This year I am a part of a very special team (Team IRA) that is paying tribute to Ira Zaslow by running the New York City Marathon. Ira, a very special father, husband, friend and colleague was suddenly taken from our lives on September 11, 2001 at the World Trade Center Disaster. The Ira Zaslow Foundation has been established in order to provide our children with a safe and encouraging environment to grow and play in, to acknowledge children who excel in academics and sports and to promote peace, fairness and understanding among all cultures in our community.

Will you sponsor me?

YES, I will sponsor _______________________________________(Please Enter Your Runners Name Here), in the effort to support Ira’s community, the programs and events of the Ira Zaslow Foundation and those tragically affected by the events of September 11, 2001.

I will Pledge:                                ______ $1.00 per mile for a total contribution of $26.20
                                                    ______ $2.00 per mile for a total contribution of $52.40
                                                    ______ $3.00 per mile for a total contribution of $78.60
                                                    ______ $4.00 per mile for a total contribution of $104.80
                                                    ______ $5.00 per mile for a total contribution of $131.00
                                                    ______ $10.00 per mile for a total contribution of $262.00
                                                    ______ $25.00 per mile for a total contribution of $655.00
                                                    ______ $100.00 per mile for a total contribution of $2,620.00
                                                    ______ OTHER $_________________________________

Name: _____________________________Company: _______________________________

Address: __________________________________________________________________

Phone #:____________________________Email Address: ___________________________

Make your check payable to The Ira Zaslow Foundation
Your donation is tax deductible
Please mail this form and your donation to:
Ira Zaslow Foundation
136 E. 55th Street, Suite 5G
N.Y.C., N.Y. 10022