Name______________________________________________________Date____________________

Phone Number or Email _______________________________________________________________

Amount of Pledge_____________________ PLR Membership Number __________________________

You will not be charged until the $35,000 goal is reached. You will be contacted before any charges are applied.

You can email your pledge to czingaro@tampabay.rr.com (be sure to answer all the questions) or

Print out this form and fax your pledge to 813-949-5862