Skip Form Below and Donate COMMUNITY CAMPAIGN PLEDGE FORM Phone Please check each box that applies: Olympic Level Sponsor over $10,000 Elite Level Sponsor $9,999 - $5,000 Champion Level Sponsor $4,999 - $1,000 Medalist Level Sponsor $999 - $1 Pledge Information Pledge Information Option 1 Option 2 Option 3 Option 1 I will fulfill this pledge with a one-time payment of $ on Date Option 2 I will fulfill this pledge through monthly payments of $ on Date Option 3 Other? Please Specify: Method of Payment Cash* Check/Money Order* Credit Card (Visa, Discover, MasterCard, Other)** *Make all checks/money orders payable to “Friends of Milton Pool, Inc.” PO Box 188, Milton, WI 53563* **If paying by Credit Card please donate online at https://friendsofmiltonpool.com/donate/** Please recognize my gift as follows: I wish to remain anonymous. Yes No Full Name Address City State - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Email Address * Phone # Signature Click Here to Sign Date Friends of Milton Pool, Inc. is a 501(c)(3) non-profit organization. Contributions to Friends of Milton Pool, Inc. may be tax-deductible to the fullest extent permitted by law. Please check with you personal tax advisor regarding the deductibility of your gift.