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SPONSORSHIP FORM The bearer of this form is an official entrant of the Active Annual Charity event, 21 st February 2011. He/She has undertaken to complete this two hour, fun packed workout to raise funds for the Jersey Cheshire Home and The Stroke Association – Jersey charities. Please be as generous as possible in your support! Thank you.

Participants Name:…………………………………………..................... Address:…………………………………………………………………. ……………………………....................................................................... Tel:………………………………………………………………………. Sponsor’s Name and Contact number

Donation £

Amount Paid & Date


Sponsorship Form