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Be a Presenting Sponsor

.

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Payment options appear after this form.   
 

OR

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

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

Charlene Mixa

5048 Pinnacle Drive

Oldsmar, FL  34677

For additional information, call:

727.753.3111

Submit the form above and pay by credit card below:

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

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