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March of Dimes Fund-raising Report Form Please fill out completely and return with your donation to the local March of Dimes chapter by May 15. To find your local chapter, visit www.marchofdimes.com/youth and enter your zip code in box at the top of the page. Keep a copy for your records. For more information contact missionliftinfo@marchofdimes.com or 800.771.FBPB. Please type or print legibly.

Contact Information Date:_ ________________________________________________________________________________________ Check One:

o FBLA-Middle Level

o FBLA

o PBL

Chapter Name: _________________________________________________________________________________ Adviser Name:__________________________________________________________________________________ Mailing Address:_ _______________________________________________________________________________ City/State/Zip:_ ________________________________________________________________________________ Daytime Phone: (_____)___________________________ E-mail:________________________________________ Involvement Please check event participated in and fill in all information requested.

Event

Date

Location of Event

Total Dollars Raised

March for Babies WonderWalk WalkMania Mini March for Babies Mission LIFT Saving Babies Dance Blue Jeans for Babies Bean Bags for Babies Jail’n’Bail Paper Cutout Sales Pumpkins, Bracelets, Sneakers

Awareness Bands Other: Other:

Total Dollars Enclosed Thanks for your support as we are saving babies, together!

NOTE TO MARCH OF DIMES STAFF: Please enter the amount raised in CWMS under the appropriate category: FBLA March or PBL March and FBLA MissionLIFT or PBL MissionLIFT. For questions, contact teamyouth@marchofdimes.com. Thank you!


FBLA March of Dimes Report