Pledge Your Support for Mohammad Arafat Tadikella

50% of your pledge will be donated to Dancey Family - Cystic Fibrosis Peterborough Chapter
50% will be donated to BEL Rotary

Fill out the form below to pledge your support.

Participant/Team:	Mohammad Arafat Tadikella
First Name: *
Last Name: *
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Postal/Zip Code: Must match billing statement
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Payment Method: *	Credit Card
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Donation Amount: *	$25 $50 $100 $200 Other $ Please only type whole dollars in the amount field. Donations under $10.00 are not supported.
Anonymous:	(Checking this will hide your name except for taxation purposes)
Privacy Agreement:	I understand that my contact information may be shared with Dancey Family - Cystic Fibrosis Peterborough Chapter for receipting purposes.