Welcome to Mercer University's 2024-2025 United Way Workplace Campaign! Your Gift to United Way Matters! And Every Donation Counts! Image Image Image Image WORKPLACE PLEDGE FORM Your Contact Information I am a... Current Mercer Employee Friend of Mercer Your Name First Middle Last Mercer Issued Email Personal Email Phone Number Your Contact Information Address Address 2 City State GeorgiaAlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP Code Company Name Employee ID# Recognition This is a joint gift with my Spouse/Partner (Mark if applies) Name of Spouse/Partner Company of Spouse/Partner List My/Our Name in publication as: Rollover Pledge By selecting Rollover Pledge you are agreeing to automatically rollover your 2023 (last year's) Payroll Deduction ONLY campaign donation to this year’s 2024 campaign with no changes. Please Rollover My 2023 Pledge Donation Options Donation Method Payroll Deduction Credit/Debit Card *If you would like to make a cash or check donation, please contact Jan Crocker to get a paper pledge form at crocker_jh@mercer.edu Payroll Deduction Contribution Amount Per Pay Period $50 $25 $20 $10 $5 Other... $ My Pay Period is: Every two weeks (26 pay periods) Monthly (12 pay periods) Attention: Payroll deduction is an option for current Mercer employees only. Please select a different option to complete your pledge. Credit/Debit Card Donation Once you finish this form, you will proceed to the payment form to process your credit/debit card. Be sure to enter the same amount on the payment page as you enter on this form. Select Card Occurence One Time Donation Monthly Recurring Donation Quarterly Recurring Donation Amount of One-Time Donation $ Monthly Contribution Options $5/month ($60 annual) $10/month ($120 annual) $25/month ($300 annual) $50/month ($600 annual) $100/month ($1200 annual) $250/month ($3000 annual) Quarterly Contribution Options $50/quarter ($200 annual) $125/quarter ($500 annual) $250/quarter ($1000 annual) $500/quarter ($2000 annual) $1000/quarter ($4000 annual) $1250/quarter ($5000 annual) After completing this form you will be redirected to our payment page where you will be able to process your transaction in a secured environment. Please be sure to enter the same values that you have entered on this form. Thank you! Total Annual Contribution ANNUAL TOTAL: $ 0 Update Caring Club Card Enjoy Special Rewards! By donating $156 ($3 a week) or more annually, you automatically enjoy the rewards of a Caring Club membership. You will receive great discounts on food, entertainment and valuable services. I qualify for the Caring Club Card Workplace Location Select Your Location-Please Select Only One Macon/Middle Georgia Atlanta Columbus Douglas County Henry County Savannah Valdosta Designations Choose Where to Make an Impact United Way of Central Georgia- United for ALICE Impact Fund (best way to help the most local people) United Way of Central Georgia Programs & Initiatives Other: United Way of Central Georgia Programs & Initiatives Read United Birth Through Eight Community Schools United Brookdale Resource Center Pink Promise United Mission United Birth Through Eight Initiatives The Basics First Steps Parents As Teachers Dolly Parton Imagination Library Other: You are donating to United Way of Greater Atlanta. Please choose where to make an impact: Community Fund Make a Designation Designation Agency You are donating to United Way of the Chattahoochee Valley. Choose where to make an impact: Community Fund Community Schools Make a Designation Designation Agency You are donating to United Way of the Coastal Empire. Choose where to make an impact: Community Fund Make a Designation Designation Agency You are donating to Greater Valdosta United Way. Please choose where to make an impact: Community Fund Make a Designation Designation Agency Donor Notes Additional Donor Details Mark all that Apply I am a first time donor Loyal Contributor Are you a Leadership Giver? I am interested in being a volunteer How many years have you contributed? Agreement My signature below, confirms my payroll deduction request as stated above. If donating by credit card, place your signature below, and click on proceed to payment page and fill out credit card payment form. Signature (press down and drag your cursor inside the box to sign) Reset Date Proceed to Payment Page Submit
