Family Medical Center United Way Pledge Form

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1. MY INFORMATION

United Way respects your privacy.  We never share donor information.



2. MY GIFT

LEADER'S CIRCLE GIVING LEVELS
I prefer that my gift remain anonymous
WOULD YOU LIKE TO ADD $30 TO SPONSOR A CHILD?
Please select one method of payment:


3. MY INVESTMENT

Check all that apply
How to designate your gift (you may choose more than one):


4. MY APPROVAL

Date