1. Contributor Information

 

First Name


Last Name

Address

City/Town

State

Zip

 

 

  2. My Gift / Payment Options

 

 

 

 

      PLEDGE

I am pledging a gift of $ to be paid in (select one) installments. 
Please bill me

      CHECK

I am enclosing check or money order number
(Please make checks payable to JH Campaign for United Way) 

      CHARGE

($50 MINIMUM) Please charge my credit card for the amount of my pledge:
Card Name   Account Number: ___________________ Expires:__________

I will call my credit card information in - please call (401 728 1800)
I will print and mail in my credit card information.

 

   3. Recognition Preference

I/We prefer to remain anonymous.     Please list my / our name(s) as shown below:   

If you would like your pledge to be a memoriam, please provide the following information:

in memory of name
your name(s):  
Send acknowledgment to:
(Acknowledgement will be sent after full payment)



   4. Optional  (Complete this section only if you choose to designate all or part of your pledge.)

   

Targeted Care Fund

 

I would like to target my gift to one or more of the impact areas listed below.

(Check appropriate impact area and fill in amount.)

 

  Fund for Accessible Living

$ The Fund for Accessible Living provides grants to individuals an families for adaptive devices and structural modifications.

 

  Fund for Adaptive Arts

$ The Fund for Adaptive Arts supports community and adaptive arts and arts education programs and a gallery and studio programs for professional adaptive artist.

 

  Fund for Inclusive Communities

$ The Fund for Inclusive Communities promotes the social, economic and political citizenship of persons with disabilities.

 

  Fund for Children’s Futures

$ The Fund for Children's Futures supports programs, services and equipment that enable children with disabilities to engage in activities that promote cognitive and social growth.

 

Please click on submit to start the printing process

Once printed please mail it to UCP Rhode Island

PO Box 36, Pawtucket, RI  02862