2009 Great Falls Polar Bear Plunge

INCENTIVE ORDER FORM

Please complete the form below to redeem your prize by DECEMBER 18, 2009
Plunge Participant Information:
First Name:      Last Name:

Team Name:
Address: 
City:    State:   Zip Code:
Phone:   
E-Mail:
Funds Raised: 
I have earned the following incentive:
(incentives will be ordered based on actual funds received, including funds raised through FirstGiving)
 Prizes are Not Cumulative - SELECT ONLY ONE ITEM
 

Chilly Level

  Official Polar Bear Plunge Bath Towel

Frigid Level ($250-$499)

  Official Polar Bear Plunge Sweatshirt

Frozen Level ($500-$999)

  Official Polar Bear Plunge Microfleece Vest

or Polar Plunge Sweatshirt (above)

Frostbite Level ($1,000-$1,499)

  Official Polar Bear Plunge Soft-Shell Jacket

or Microfleece Vest or Sweatshirt

Arctic Level ($1,500 and above)

  iPod Nano
or Jacket or Vest or Sweatshirt

  Color Preferred (not guaranteed)

Please verify information is correct before submitting

      

Thank your for supporting Special Olympics Montana athletes!