Audrey's Purple Dream
“Our Answer To Cancer”
12th Annual Purple Plunge
February 11, 2017
Audrey's Purple Dream is dedicated to the memory of Audrey Faye Pidde, a life long resident of Akeley, Minnesota. After a heroic battle against cancer Audrey passed away on March 24th 2005. One of Audrey’s last wishes was to go to Alaska. Audrey had many friends and many family members who helped make the original purple dream happen in February of 2005, on 11th Crow Wing Lake. The event raised almost $10,000 to send Audrey to Alaska. Unfortunately the cancer didn’t give Audrey enough time to realize her dream, but the money raised did make a huge impact on the last few weeks of Audrey’s life. It enabled her to pay medical bills and other expenses, giving her some peace of mind, and most of all it let her know how much people care. Now the Annual Purple Dream will raise funds to help other local cancer victims and their families.
For myself and on behalf of my minor children and/or legal ward do agree to hold harmless, release and discharge any and all volunteers who may be associated with Audrey's Purple Dream Purple Plunge or others acting on its behalf (hereinafter collectively referred to as “Dream Team”), of and from all claims, demands, causes of action against Audrey's Purple Dream, for any economic and non-economic losses due to bodily injury, death, property or bodily damage sustained by me and/or my minor children and/or legal ward in relation to Audrey's Purple Dream.
Plunger's Name: ______________________________
I WILL NOT JUMP HEAD FIRST
I am the legal guardian of and represent the following minor children who may participate
in the Audrey's Purple Dream Purple Plunge
Signature / Date
1. We reserve the right to refuse to let any person plunge for any reason we deem necessary.
2. Consent Form must be signed. For those Purple Plungers under 18 years old, you must have legal guardian
signature before you receive a pledge form.
3. All Forms and Money MUST BE TURNED IN BY 1pm on Feb.11th, 2017 in the Registration tent.
4. For more info or more pledge sheets call Shannah @ 218-252-9993 or visit our website at www.audreyspurpledream.com .
This form MUST be turned in before you receive a pledge form!
City State Zip Code: _________________________________
Phone Number: _________________________________
E-Mail Address: _________________________________
Age if under 18 yrs. Old: _______
Shirt Size (Adult): S M L XL 2XL 3XL Children’s Size: S M L
Please fill out the following information and turn in with your money on Feb. 11th:
Age: (If under 18) ______
Where are you from? (City & State) ________________________
Why do you plunge or who are you plunging for? ________________________________
Amount of $ Raised: ________________
Purple Plunge registration form