SubZero SuperHero Polar Plunge Incentive Form

2010 SubZero SuperHero Polar Plunge

INCENTIVE ORDER FORM

Please complete the form below to redeem your prize by APRIL 5, 2010

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 in addition to your official plunge shirt

Your Incentive order will be placed after all orders have been received by April 5th.

We will contact you as soon as they are available. Thank you!

Goosebumps Level ($100-$249)

Official SubZero SuperHero Polar Plunge Shirt

only order if you did not receive your shirt at the plunge

Chilly Level ($250-$499)

Polar Plunge Sweatshirt

and shirt

Frozen Level ($500 - $999)

Polar Plunge Vest

and shirt

Frigid Level ($1000 - $1499)

Soft-Shell Jacket

and shirt

Arctic Level ($1,500 and above)

iPod Nano (8g)

and shirt

Please verify information is correct before submitting