Bike for the Cure Pledge Form
			Hardwood Hills Mountain Bike Centre, Barrie, Ontario - June 5, 2004
			Last Name:				First Name:
			Address:
			City:				Province:		Postal  Code:
			Phone:				Email:
PLEASE PRINT CLEARLY											Receipt
Donor Name			Address			City	Province	Postal Code	$ Pledged	$ Collected	Req'd?
Please make cheques payable to the CANADIAN BREAST CANCER FOUNDATION.									Total
Tax receipts are automatically issued for donations of $20 or more.  For donations less than $20 please indicate if receipt required on pledge form.
Pledger's name & address must be complete and legible.  Pledge forms and collected pledges should be submitted to the CBCF Pledge table at the event on June 5, 2004
or mailed by July 15, 2004 to the address below.
					Thank you for your Support!
		Canadian Breast Cancer Foundation, Ontario Chapter, 20 Victoria St., 6th Floor, Toronto, Ontario  M5C 2N8
	Phone #  416-815-1313 / 1-866-373-6313  Fax # 416-815-1766						Charitable registration # BN 12799 3608 RR0001