East Coast Cycle Challenge - Sponsorship Tally Sheet 

The following requested information relates to the person who is collecting sponsors on behalf of a rider
Fundraisers Name: 
Fundraisers Address: 
Fundraisers Telephone number: 
Rider on whose behalf you are seeking sponsorship: Darren Fittler

The East Coast Cycle Challenge is a Registered Charity for the Blind Citizens of Australia - ABN 90 006 985 226

Please return this Tally Form and Cheque or Money Order to:
Blind Citizens Australia
PO Box 24
SUNSHINE Vic 3020
Note: Cheques or Money orders should be made out to Blind Citizens Australia - East Coast Cycle

The following requested information relates to the people who have agreed to sponsor a rider and will help you keep track of how much people have pledged and how much of the agreed sponsorship money you have collected 
Note: If you collect more than 20 Sponsors please just add more at the bottome of the form!

Sponsor 1
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 2 
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 3 
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 4
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 5
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 6
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 7
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 8
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 9
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 10
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 11
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 12
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 13
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 14 
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 15
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 16
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 17 
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 18 
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 19
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no 

Sponsor 20 
Sponsors Name: 
Sponsors Address:
Sponsors telephone number: 
Receipt Required:  yes no 
Dollar per Kilometer or donation: 
Total amount: 
Paid: yes no