Return to Main Menu

Trident United Way Campaign Form Please circle:  CFC     MUSC    UMA*     MUHA  Dr./Mr./Mrs./Ms.:___________________________________Home Phone:_________________________  SS#:______________________Unit__________________Work Phone:___________  Home Address:_______________________________________________________________  City:_________________________________State:____________Zip:_____________  * UMA employees are eligible for a straight dollar-for-dollar match for all gifts between the amounts of $250 and $500. Call 792-1973 for more information. YES! I want to make a difference with my community care gift!    Payroll Deduction: I authorize my employer to deduct the following amount per pay period: Please check the appropriate box  2% of my pay  1% of my pay  1 hour's pay per month  $40  $25  $10  $5  Other (Please specify) $________ My pay period is:  ___Every two weeks   ___Monthly  Signature:___________________________________________________Date:_________________________        I understand that my gift will continue until modified by me    Cash  Check (Make checks payable to Trident United Way) Credit Card: Type_____________ Number________________________ Exp. date_________ I wish to utilize my UMA Matching Gift option. Total gift including match is $________ Stock (a Trident United Way representative will contact me)  My gift of $1,000 or more qualifies me for membership in the Palmetto Society. Please list me in the Palmetto Society roster as _________________________________________________  _____ I have already remembered Trident United Way in my will. _____ I am interested in remembering Trident United Way in my estate plans. Send me more information.  Thank You  For information call 792-1973. Fax pledge form to 792-8934 or campus mail to TUW/Office of Development, 21D Ehrhardt St., P.O. Box 250182. If you want your donation to be designated for a specific agency fill out the information below ____I would like Trident United Way, guided by experienced volunteers from our local area, to ensure that my contribution is used within Berkeley, Charleston and Dorchester counties in the manner in which it will benefit those of my neighbors who need the most help. ____Please ensure that the following amount(s) from my gift are used in targeted programs that specifically: ___Nurture Children and Youth.........................$_____ ___Strengthen Families......................................$_____ ___Support Older People...................................$_____ ___Promote Health and Healing.........................$_____ ___Increase Self-Sufficiency..............................$_____ ____I would like a portion of my contribution to go directly to a specific 501(c) 3, non-profit, helth and human service organization in South Carolina. Agency Name_______________________  Agency Code _________ $_______ Address (if agency is not listed) or call 792-1973 if unsure.  MUSC Annual Fund Office, 268 Calhoun St., PO Box 250182, Charleston, SC 29425 (843) 792-1973