2013 Employee Giving Campaign

Please complete the form below and submit. Invest your charitable giving at UCC and Help Us Grow!

Name

Home Address

City State Zip

Email Address

I want my gift to be anonymous.

MY GIFT

Payroll Deduction: (Jan 2013 - Dec 2013) I pledge a gift per pay period of $ .

Total annual gift pledged: $

Please continue to deduct this amount until I request a change in writing to Payroll.

In addition to my current payroll decution I would like to contribute an additional gift per pay period of $

Cash/Check in the amount of $ (payable to UCC Foundation)

Please charge $ to my credit card

If you are paying with your credit card, please contact Ellen Brown at (541) 440-7847.

If you would like, you may direct your gift to any, or all, of the following:

To Direct your gift to a specific area, please list amount and fund below.

Other * $

* The Foundation Office will contact you directly to determine a specific fund for your contribution.

MY AUTHORIZATION

By submitting this form, I authorize my gift.       Date

Please enter the text displayed on the image below.