MY INFORMATION Name Title Title - None -MissMsMrMrsDrOther… Enter other… First Last Home Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Email Cell Phone Number Work Phone Number My Employer: Date of Birth How many years have you been a United Way donor? MY INVESTMENT Check all that apply: I am retiring this year, please keep in touch I am interested in volunteer opportunities I want to contribute the following amount per pay period: $38.50* Your gift of $38.50 per bi-weekly pay period qualifies you in a Giving Community. $25 $15 $5 Other… Enter other… I am paid: Weekly (52) Bi-Weekly (26) Bi-Monthly (24) Other… Enter other… My annual gift: MY IMPACT I want to give to: United Way of Greater New Bedford's Community Impact Fund: the most efficient and effective way to invest in United Way’s work in health, education, financial stability, and basic needs. Another Non-Profit Organization: You can choose to designate your gift of $104 or greater to one specific organization. It must be a tax-exempt 501(c)(3), not fraternal, political, or religious in nature. They may use these funds at their discretion and u Enter the name of the organization you'd like to designate your gift to: *Your gift of $1,000 or more per year ($38.50 per week) qualifies you for membership in a United Way giving community. As a member, you will receive invitations to special events, exclusive volunteer opportunities, and listing in our annual report. Navigator Society - Supports community impact initiatives Women United - Supports early childhood development and literacy initiatives OPTIONAL: My contribution is part of a household gift. Please combine my pledge with: Please list name and company affiliation. I / We would like to be acknowledged as: By checking this box, I pledge to make the gift above through payroll deductions at my company. I want to join the fight for health, education, financial stability, and basic needs in my community.
