All nonprofits receive 100% of contributions directed to them.

} My gift total forthe year is $ ________

Gifts to Community Shares of Wisconsin and its member nonprofits are tax deductible as allowed by law.

Name Date

Employer

Home Address City State Zip

Home Email

YOUR SUPPORT I pledge my support to Community Shares of Wisconsin as follows:

m I authorize my employer to deduct the amount of $ _______ each pay period in 2016 for _____ pay period(s) until my pledge of $ ________ is paid in full.

Authorization signature:

m I have enclosed a check/cash gift in the amount of $ _________ (Make checks payable to Community Shares of Wisconsin.)

m I am charging my gift in the amount of $ __________ m VISA m MASTERCARD m DISCOVER m AMERICAN EXPRESS

Card # Expiration date

Signature Date

m Please bill me in the amount of $ ________. q Before year end 2015 q In January 2016

m I would like to give a gift of stock, please send details. m Please send me information about making a planned gift.

YOUR CHOICE A gift to Community Shares supports ALL groups: $ ________. And/Or I direct a total of $ _________ to the groups as indicated below.

$ ________ 1000 Friends of Wisconsin

$ ________ ABC for Health

$ ________ ACLU of Wisconsin Foundation

$ ________ Arts Wisconsin

$ ________ Bayview Foundation

$ ________ Center for Media and Democracy

$ ________ Center for Resilient Cities

$ ________ Chrysalis

$ ________ Citizens for Safe Water Around Badger

$ ________ Citizens Utility Board

$ ________ Clean Wisconsin

$ ________ Coalition of Wisconsin Aging Groups

$ ________ Common Wealth

$ ________ Community GroundWorks

$ ________ Dane County TimeBank

$ ________ Disability Rights Wisconsin

$ ________ End Domestic Abuse Wisconsin

$ ________ Fair Housing Center of Greater Madison

$ ________ Fair Wisconsin Education Fund

$ ________ Freedom Inc.

$ ________ Friends of Wisconsin State Parks

$ ________ Gathering Waters: Wisconsin’s Alliance for Land Trusts

$ ________ Grassroots Empowerment Project

$ ________ GSAFE

$ ________ Housing Initiatives

$ ________ Interfaith Coalition for Worker Justice

$ ________ League of Women Voters of Wisconsin

$ ________ Legal Action of Wisconsin

$ ________ Linda and Gene Farley Center for Peace, Justice, and Sustainability

$ ________ Madison Area Community Land Trust

$ ________ Madison Audubon Society

$ ________ Midwest Environmental Advocates

$ ________ NARAL Pro-Choice Wisconsin Foundation

$ ________ New Harvest Foundation

$ ________ Nuestro Mundo Inc.

$ ________ OutReach

$ ________ Perfect Harmony Men’s Chorus

$ ________ Physicians for Social Responsibility—Wisconsin

$ ________ The Progressive

$ ________ Project Home

$ ________ Rape Crisis Center

$ ________ REAP Food Group

$ ________ River Alliance of Wisconsin

$ ________ Rock River Coalition

$ ________ Sierra Club Foundation-John Muir Chapter

$ ________ Sustain Dane

$ ________ Tenant Resource Center

$ ________ UNIDOS Against Domestic Violence

$ ________ Wisconsin Alliance for Women’s Health

$ ________ Wisconsin Coalition Against Sexual Assault

$ ________ Wisconsin Council of the Blind and Visually Impaired

$ ________ Wisconsin Council on Children and Families

$ ________ Wisconsin Democracy Campaign

$ ________ Wisconsin Early Childhood Association

$ ________ Wisconsin Family Ties

$ ________ Wisconsin Farmer’s Union

$ ________ Wisconsin League of Conservation Voters Institute

$ ________ Wisconsin Literacy

$ ________ Wisconsin Network for Peace and Justice

$ ________ Wisconsin Wetlands Association

$ ________ Wisconsin Women’s Network

$ ________ Women In Transition

$ ________ Working Capital for Community Needs

$ ________ WORT 89.9 FM Community Radio

Neither Community Shares nor its member nonprofits provide goods or services to the donor in return for contributions. Please note: Taxpayers who want to deduct charitable contributions must maintain a record of all gifts in the form of a bank record, canceled check, or a receipt. If you choose payroll contribution, keep for your records copies of a pay stub, W-2 form, or other document from your employer that indicates the amount withheld for charity during the tax year. If you don’t receive an acknowledgement/thank you within a month of submitting your pledge form, please contact us at csw@communityshares.com. Thank you!

WHITE COPY: COMMUNITY SHARES OF WISCONSIN YELLOW COPY: PAYROLL OFFICE PINK COPY: EMPLOYEE

O F W I S C O N S I N

612 West Main Street, Suite 200 • Madison, WI 53703

608.256.1066 • www.communityshares.com PLEDGE FORM

Please print information as you would like it to appear in our records.

YOUR DOLLARS AT WORK

Your gifts DO make a difference!

Your gift of $1 per pay period or about $26 per year:

• Helps someone find out how to get the paperwork they need to regis-ter and vote! (Because people now need a specific form of ID beforethey can vote.) League of Women Voters of Wisconsin

• Allows a rising student scientist to go to our Wetlands Science Confer-ence. Wisconsin Wetlands Association

• Helps us send a survivor to a local training to become an advocate forother survivors. Wisconsin Coalition Against Sexual Assault

• Helps us host a statewide webinar for those trying to come to termswith their advancing vision problems. Wisconsin Council of the Blindand Visually Impaired

• Buys compact fluorescent lightbulbs for an entire house, reducing alow-income family’s energy use. Project Home (photo at right)

Your gift of $5 a month or $60 per year:

• Helps us work intently with parents of children with mental healthchallenges, prompting one mom to say, “I am starting to see the lightof hope again.” Wisconsin Family Ties (photo at right)

• Allows us to offer our community garden plots to families on a slidingfee scale. Community GroundWorks

• Allows us to offer legal advocacy to a woman for a court appearance.UNIDOS Against Domestic Violence

• Supports our Lean on Me Direct Relief Fund—since a survivor often needs to pay for immediateneeds like medicine for a sick child, car repairs so she can drive to safety with her children, or asecurity deposit for a safe place to live. End Domestic Abuse Wisconsin

Your gift of $10 a month or $120 per year:

• Trains a team to monitor streams for pollutants. Rock River Coalition(photo at right)

• Allows our legal staff to prevent unlawful evictions. Legal Action ofWisconsin

• Enables us to host 1:1 counseling sessions, to help people understandtheir rental rights and responsibilities. Tenant Resource Center

• Allows us to create educational materials showing the impact that fracsand mines have on families living nearby. Sierra Club Foundation –John Muir Chapter

We’re your connection to social change. Thank you for giving generously!