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Be an Awareness Sponsor

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Payment options appear after this form.

Please press the "Submit" button on the form above before making payment.  

Mail check made payable to the ELW Drive for a Cure and copy of this form to:

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Charlene Mixa

5048 Pinnacle Drive

Oldsmar, FL  34677

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For additional information, call:

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727.753.3111

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OR

Submit the form above and make a credit card payment below:

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Thank you
for your registration.  We will confirm by email.

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