Please print and complete this form and mail to:

The Third Annual Matt Donaldson Triathlon
The Evan B. Donaldson Adoption Institute
525 Broadway, 6th floor
New York NY 10012

Yes, I would like to sponsor Matt Donaldson in the Iron Man Triathlon to benefit the Evan B. Donaldson Adoption Institute.  I understand sponsorship is $100 per mile.

I will sponsor:   1 mile _____  10 miles _____   25 miles _____     50 miles_____    other _____

My fully deductible contribution to The Evan B. Donaldson's Adoption Institute is:

#_____miles x $100.00 = $__________

Other donation    $__________

Enclosed is my check in the amount of $__________ made payable to
The Evan B. Donaldson Adoption Institute.

Name___________________________________________________________

Address_________________________________________________________

City _____________________________ State ___________   Zip___________

Phone ___________________________E-mail ___________________________