Loyal Contributor On-line Registration Form

We want to recognize you as a Loyal Contributor. If you have donated to United Way, in any community, for ten or more years, you are a Loyal Contributor.

Please let us know you are a Loyal Contributor by completing the form below.


Full Name

Street Address  
City   State    Zip 
Home or Cell phone number
Work phone number  
Preferred email is work or home
Preferred email
Employer
I have been donating to United Way since year (approximate is okay)
My gifts have been:  Individual or Combined with a member of my household
Name of combined giver 

I am interested in a planned gift to United Way:  Yes or No

  

  

Enter above code

Upcoming Events

7th Annual Power of the Purse
June 19th, 2012 at 10:30 am
The Kahler Grand Hotel