INCENTIVE ORDER FORM

I have earned the following incentive level:

Please select your item below.  All plungers will receive incentive based on actual funds raised.  You will be contacted via email when your incentives are available for pick up.

Brrr... Level - up to $125

  Baseball Cap

Choose Color Light Pink Apricot Khaki Steel Blue

 - or -

  14oz Stanless Steel Tumbler

 

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Goosebumps Level - $126 - $250

  Long-Sleeve Self-Wicking Tee

Choose Size Small Medium Large XL 2X 3X   Choose Color Forest Maroon Royal

 

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Chilly Level - $251 - $500

  Duffle Bag

Choose Color Carolina Blue Gray

 

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Cold Level - $501 - $1,000

  Soft-Shell Jacket

Choose Size Small Medium Large XL 2X 3X   Choose Color Black Atlantic Blue

 - or -

  Terry Velour Bathrobe

Choose Color Navy Blue Light Pink

 

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Frostbite Level - $1,001 - $1,500

  Portable DVD Player

 - or -

  3-in1 Coat

Choose Size Small Medium Large XL 2X 3X

 

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Frigid Level - $1,501 - $2,500

  Nintendo DSi XL

 - or -

  Xbox 360 4gb Console

 

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Arctic Level - $2,501 or more

  iPad

 

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Totally Chilled Out

  To further support Special Olympics Montana, I decline the incentive prize for which I qualify (optional).

 

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Please verify information is correct before submitting