700 18th Avenue East
Seattle, Washington 98112
phone: (206) 329-3260
fax (206) 324-7773
www.stjosephsea.org
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Sponsor's Name
____________________________________________
Address
___________________________________________________
City, State, Zip
_____________________________________________
Runner's Name
_____________________________________________
Runner's Grade and Class
______________________________
Pledge per Lap $_____________
Please Bill _________________
Amount Enclosed $___________