Untitled Document

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GIVE

Enter Your Organization's Campaign Census Here

Your 2011/2012 United Way in-house campaign coordinator(s):

Your Name:
Business Name:
Phone Number:
Fax Number:
Email Address:

Number of full-time employees?

Number of part-time employees?

What is the date of your campaign kickoff?

Would you like one or more of the following individuals to speak at your company kick-off?

	Agency
	Campaign Cabinet Member
	United Way Board Member
	United Way Executive Director

Would you like any of the following for the campaign? (enter amount)

Item:	Quantity:
Brochures
Pledge cards
Posters
Video
Thermometer
Casual Day Stickers
United Way Catalog

Please check which of the following applies to your company:

	Our company will not use the United Way pledge card.
	Our company will attach our own employee labels to the supplied pledge cards.
	We will provide printed employee labels for United Way to attach to the pledge cards.
	We will provide a list of employee names for United Way to prepare labels to place on the pledge cards.

What date will the payroll deductions begin for the 2011/2012 campaign?

What approximate date will the first check be sent for the 2011/2012 campaign?
(Please indicate on each check documentation which campaign year a check is for.)

10.

We will provide a list of names and addresses of our retirees:

	Yes
	No

11.

Suggestions for improving this year's campaign:

Don't forget to send in any lists you marked off above via U.S. mail or email.

Business Census