Be a part of one of the most exciting events happening in the Moscow area this summer ! The Mad Mudder is a charity event that will benefit the Madisonville Fire Department. The participants will take on the Mad Mudder on August 19, 2017 starting at 9:00 AM. As a sponsor, your donation will help to fund the event. All remaining proceeds from the sponsors will go directly to the Madisonville Fire Department. Join us as a supporter by selecting one of the levels below.

Sponsor Name or Business *

Contact Person *

First Name Last Name

E-mail *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number

Website

SPONSORSHIP LEVELS:

Silver $50.00 – Name on back of our T-shirt in small font size

Gold $100.00 - Name on back of our T-shirt in medium font size

Platinum $150.00 - Name on back of our T-shirt in large font size

Pay Now with PayPal *

Silver Sponsorship $ 50.00
Gold Sponsorship $ 100.00
Platinum Sponsorship $ 150.00
Total: $ 0.00

If paying by check please print this form out and mail along with your payment to:
Madisonville Mud Run
101 Meadowood Lane
Madison Twp, PA 18444
You will receive a confirmation e-mail notifying you when payment is received and check(s) cleared.

For any concerns, questions or other payment options please contact us at madmudrun@yahoo.com

MAD MUDDER SPONSOR AND PAYMENT FORM