Thank you for your support! This is an active form that you can fill out and print, or print and fill out later and mail with your check, cash, money order or certified check. Please mail a copy of this completed form, along with your contribution to: Robin's Ride for Women R. A. Mahaffey Promotions, Inc P. O. Box 2073 Bothell, WA 98041 Fax: 360 874-0354 Cell Phone: 206 612-9145 Email: robin@robinsrideforwomen.com

Pledge Type Per Mile Standard   $0.01   $5.00 If you would like to enter a different amount, please select "Other" under the "Per Mile" or "Standard" column, then enter the amount you would like to pledge below. $ $0.02   $10.00 $0.03   $25.00 $0.04   $50.00 $0.05   $100.00 $0.10   Other $0.25       $1.00       Other

First Name*  Last Name*  Address*  City*  State*  Zip*  Country*  Phone*     Ext.  Cell     Fax     Email*  Website

© 2006 R A Mahaffey Promotions, Inc www.robinsrideforwomen.com robin@robinsrideforwomen.com