live united®

tell uS ABOut YOuRSelF

Mr/Mrs/Ms/dr first naMe last naMeMi

hoMe address suite/apt no

city state zip code hoMe phone

eMployer work phone

work eMail address

GendeR Male feMale

what year did you first give or volunteer at any united way?

� please contact me about how i can improve lives in our community by creating a legacy gift for the future.

last year’s contribution $___________

signature (required to process pledge) date

mAke YOuR cOntRiButiOn

total contribution: $ (for contributions of $1,000 or more, join leadership circle in step 3)

� easy Payroll deduction per pay period: $50 $25 $10 $7 other $ no. of pay periods: for your tax records, the irs requires you to keep a copy of this pledge form along with your payroll receipt, w2 or other employer documents to verify any payroll amount withheld and paid to united way.

� One time contribution (enclosed): check (payable to united way) or cash $ � credit/debit card once Monthly quarterly i wish to give this amount per payment: $ begin billing (mo.) (yr.)

Visa Mastercard amex discover account no. exp / (MM / yy)

� Stocks/Securities appreciated stocks and securities might provide tax benefits. please call 515-246-6511 to facilitate.

� intend to Recommend from a donor-advised fund � Please Bill me (a home address and minimum contribution of $50 is required). begin billing (mo.) (yr.)

FOR UWCI USE: # date:

JOin leAdeRShiP ciRcle

Tocqueville Society (TS) members are leaders among leaders. TS recognizes those who contribute $10,000 or more.

� i am/we are joining or renewing our TS membership with a contribution ($10,000 or more).

� i am/we are participating in the TS step-up program and i/we commit to continue the step-up program as shown on the back.

Women’s Leadership Connection (WLC)supports strategies to improve kindergarten readiness.

please direct $___________________ to WLC.This amount will be directed to improve kindergarten readiness before any other optional agency contributions listed below.

� i am/we are joining or renewing our WLC membership at the lead level with a $2,500 (minimum) contribution to WLC.

� i am/we are joining or renewing our WLC membership at the member level with a $1,000 (minimum) contribution to WLC.

� i am/we are participating in the WLC step-up program and i/we commit to continue the step-up program as shown on the back.

Education Leadership Initiative (ELI) supports strategies to ensure youth succeed in school.

please direct $___________________ to ELI.This amount will be directed to school success before any other optional agency contributions listed below.

� i am/we are joining ELI at the lead level with a $2,500 (minimum) contribution to ELI.

� i am/we are joining or renewing our ELI membership at the member level with a $1,000 (minimum) contribution to ELI.

� i am/we are participating in the ELI step-up program and i/we commit to continue the step-up program as shown on the back.

white copy: united way pink copy: eMployer yellow copy: donor

This section OPTIONAL. $50 minimum required for a donor-directed contribution to a specific agency. An administrative fee will be deducted. For more information, please refer to our web site at www.unitedwaydm.org/designations.

Please direct $ to specific agency (name) Do not release my name with this donation.

Please direct $ to specific agency (name) Do not release my name with this donation.

tocqueVille society: $10,000 + gold bridgebuilders: $5,000 silVer bridgebuilders: $2,500 partners in leadership: $1,000

� this is a joint contribution with my spouse/partner. spouse/partner name_____________________ employer___________________________

please list me/us in recognition materials as _______________________________________ i/we wish to remain anonymous in recognition materials.

Find more information about tS, Wlc and eli on the back of this pledge form.

suffix

hoMe eMail address

Wlc and eli lead ($2,500)$$$

1,5002,0002,500

minimum

United Way of Central Iowa Tocqueville Society (TS)Recognizes exceptional individuals and families who lead the way. Benefits include:

•Recognition in United Way of Central Iowa’s Community Report and on its web site•Timely communications about the results of your investments• Invitation to Tocqueville Society events

United Way of Central Iowa Women’s Leadership Connection (WLC)Connects women who want to ensure children begin kindergarten ready to learn. Benefits include:

•Networking and volunteer events •Annual community recognition and photo recognition for Lead WLC in the Des Moines Business Record and

The Des Moines Register•Recognition on the United Way of Central Iowa web site•Regular e-communications related to WLC investments and activities

United Way of Central Iowa Education Leadership Initiative (ELI)ELI helps ensure that youth succeed in school. Benefits include:

•Networking opportunities with community and business leaders •Professional development and volunteer opportunities•Annual community recognition and photo recognition for Lead ELI in the Des Moines Business Record•Recognition on the United Way of Central Iowa web site•Regular e-communications related to ELI investments and activities

Become a Member TodayStep-up your contribution over three years. Enjoy networking, learning and volunteer opportunities now.

1111 Ninth Street, Suite 100Des Moines, Iowa 50314

515-246-6500www.unitedwaydm.org

Your United Way of Central Iowa contribution, when not directed to a specific agency, will build a stronger community through EDUCATION, INCOME and HEALTH, the building blocks to a better life for all. Join us in making this bold vision a reality for everyone.

live united®

ABOut tS, Wlc And eli To join, please see front side, step 3.

OuR cOmmitment tO YOuUnited Way of Central Iowa will not sell, rent or loan your information and does not provide goods or services as whole

or in partial consideration for any contribution.

Step-up Your contributionyear 1year 2year 3

Wlc and eli member ($1,000)$$$

500750

1,000

minimum5,0007,500

10,000

tocqueville Society ($10,000)$$$

minimum