Walk-A-Thon Online Pledge Form
The Walk-A-Thon will benefit the University of Ottawa Heart Institute. A minimum pledge of $10.00 will receive a donation receipt from the Heart Institute. As we did last year, Deshantari will collect all cheques, payable to "Univ. of Ottawa - Heart Instute". All "Cash" pledges will be collected by Deshantari and passed on to the Heart Institute.
If you can't participate, pledge another participant or simply donate.

Amount	$
First Name
Last Name
Company Name
Do you want a receipt? (Only if >$10.00)	Yes No
Are you participating in the walk-a-thon?	Yes No If "No", Pledge a participant:
Address (Required for Receipt)	Street Street 2 City Prov. Area Code
Telephone

For additional information, email Tapas Chowdhury