EAST CENTRAL

MINNESOTA

WORKFORCE

PARTNERSHIP

Pledge Form

Name: _______________________________________________

Company: ____________________________________________

Address: _____________________________________________

City: _________________________ State: _____ Zip: ________

Phone: ____________________ Date: ____________

Pledge: Year

2001-2002 $__________________

2002-2003 $__________________

Total 2 year Pledge: $___________________

Amount Paid: $___________________

Payable to: East Central MN Workforce Partnership

Attn: Ray Hoheisel, Executive Director

138 SW 20^th Avenue.

Cambridge, MN 55008-2510

Balance Due: $___________________ (Invoiced by ECMWF)

Signature: ___________________________________