Central Michigan District Health Dept. Pledge Form

County

I would like my gift to go here:

Clare

Gladwin

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

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United Way invests in organizations that are impacting the areas listed below. We strive to ease our affiliate partners fundraising burdens, so they can focus on doing what they do best — serving the individuals in our communities.

If you prefer, you may designate your contribution to a specific local nonprofit organization by choosing "Other"

Community Care Fund - the MOST POWERFUL WAY to invest in your community

Education - Strengthening family programs for children and youth, crisis intervention

Income - Basic Needs, emergency assistance, assisting seniors

Health - Health and wellness, reducing substance abuse, child abuse and domestic violence

Other - MUST be an IRS 501c3 certified Human Services Agency

Leadership Giving Honor Roll

A gift of $500 or more (or a gift combined with a spouse's gift, qualifies you/both for the Leadership Giving Honor Roll that is placed in local print and media. Your name will be listed in as it appears on this form unless otherwise indicated.

I prefer my donation remain anonymous

Volunteer

Please check the box if you are interested in serving on the panel of community members who will help decide how to distribute funds raised during this United Way campaign

I'd like to be on the panel

I would like my gift to remain anonymous

Yes

No