Please complete the form, contact the office at 815-232-5184 if you have any questions. Campaign Coordinator Name Organization Phone Number E-mail Total Number of Employees Campaign Start Date Start date of payroll deduction Would you be interested in a Virtual Campaign? - Select -Yes, please No, thank you Maybe, I would need more info on how this works What Campaign Materials will you need? Pledge Cards Brochures Posters Thermometer Casual Day Stickers Live United T-Shirts And Other Merchandise Are Available At A Minimum Cost, Contact Us For More Information Please check which of the following applies to your company: - Select -We are going to do a virtual campaignOur Company will not use the United Way pledge cardOur Company will attach our own employee labels to the supplied pledge cardsWe will provide a list of employee names for United Way to prepare labels to place on pledge cardsWe would like customized pledge cards created by United Way Speakers CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Math question 11 + 7 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4. CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Math question 15 + 5 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4. Submit
