2010-11 Pledge Confirmation Form
United Way Young Leaders
* = Required fields
Leadership Giving Levels
Levels:
Alexis de Tocqueville
$10,000 or more
Leadership Circle
$5,000 - $9,999
Chairman's Club Gold
$2,500 - $4,999
Chairman's Club
$1,000 - $2,499
Gift Amount $:
If paying by credit card, please complete this form and contact
Holly Rice
at 713.685.2829.
This gift is payable by:
Payroll Deduction
Cash or Check
Credit Card
Bill Direct
Securities
*Important: In order for your company to receive credit for your gift, please be sure to complete your company's employee pledge card.
2010-11 pledges can be paid any time prior to December 31, 2011
Recognition Preferences
Unless designated below, all names will be published in the Alexis de Tocqueville Society Roster and/or the Leadership Giving Roster with the Women's Initiative designation.
Roster
To give leadership to my peers, I will allow my name to be published in the leadership giving roster. (Please list your name below exactly as you wish to appear in the roster of members.)
Name:
Company:
Anonymous
I wish to remain anonymous.
Women's Initiative
I am interested in Women's Initiative (women who make personal gifts of $2,500 or more have the chance to expand their personal and professional networks via exclusive events and activities.)
Diamond Donor
Diamond Donors (donors who have contributed to the United Way for 25 years or more at any level)
First:
Middle:
Last:
Your Spouse's Name:
Your Business:
Your Title:
Business Email:
Company Address:
Company City:
Company State:
Company Zip:
Business Phone:
Business Fax:
Home Address:
City:
State:
Home Phone:
Home Fax:
* Email:
*
Type Numeric Code Below:
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