2012 Sweetheart Passion Plunge

INCENTIVE ORDER FORM

Please complete the form below to redeem your prize by FEBRUARY 27, 2012

Plunge Participant Information

Name:

Team Name:

Address:

City:

State:

Zip:

Phone:

E-Mail:

Incentives

Goosebumps Level - $100

  Official Plunge Sweatshirt (select if you DID NOT receive your sweatshirt at the plunge)

 

 

Then choose one item below based on actual funds raised:

Select only one level

 

Chilly Level - $250

  Beanie (& Plunge sweatshirt)

 

Cold Level - $500

  Towel (& Plunge sweatshirt)

 

Frozen Level - $750

  Duffel (& Plunge sweatshirt)

 

Frostbite Level - $1,000

  iPod Shuffle (& Plunge sweatshirt)

OR

  Fleece Vest (& Plunge sweatshirt)

 

Frigid Level - $1,500

  iPod Nano (& Plunge sweatshirt)

OR

  Soft-Shell Jacketl (& Plunge sweatshirt)

 

Arctic Level - $2,500

  iPod Touch (& Plunge sweatshirt)

OR

3-in-1 Jacket (& Plunge sweatshirt)

 

 

Totally Chilled Out

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

 

Please verify information is correct before submitting

      

Thank your for supporting Special Olympics Montana athletes!