PBC Fund for the Cure Fun Walk

For the promotion of public awareness,

medical research and education of

Primary Biliary Cirrhosis

When: Tuesday, April 30, 2002

Where: PBC Conference, Biloxi, MS

Walk route & check-in location to be announced

Check-in Time: 9:15 a.m. - 9:45 a.m.

Walk begins: 10 a.m.

Turn in money & sponsor sheets at check-in

Prize for the most money collected!

Walker’s Name: ________________________

Make checks payable to ALF/PBC Fund for the Cure

Name_____________________________________________________ Address____________________________________________________ City, State, Zip_______________________________________________ Amount: $__________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________
Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________
Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $_________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________
Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________
Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________

Donations are Tax Deductible

(Fed. ID # 76-0622718)

Walker’s Name: ________________________

Make checks payable to ALF/PBC Fund for the Cure Page 2

Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________
Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________
Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________
Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________
Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________
Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________
Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________
Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________
Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________
Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________	Name______________________________________________________ Address_____________________________________________________ City, State, Zip________________________________________________ Amount: $__________