Sponsors may pledge either a fixed amount or a pledge per burpees performed.
For example, a pledge could be a fixed amount such as $10, or a pledge could be based on
performance, such as 50¢ per burpee. If the participant were to perform 25 burpees in 90 seconds,
then the total pledge at 50¢ per burpee would be $12.50.
Pledge monies will be collected AFTER burpees have been completed on June 22.
Sponsor Individual/
Business Name
Phone
Number
Email Address
Dollar
Amount
Pledge
Pledge
per
Burpee
Total
Burpee
Count
Total
Pledge
Collected
(Y/N)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Fitness Revolution
Participant Name
I hereby certify that the above named participant performed the following number of burpees in 90
seconds:
________ Burpees
Coach’s Signature _____________________________________________