United Way Campaign 2022 United Way Campaign 2022 My Information First Name * Middle Initial Last Name * Street Address City State Zip Personal Email Personal Phone Please Select a Facility Buckley LandingPACE CNYSedgwick HeightsThe BernardineThe HeritageLoretto Health & RehabilitationThe NottinghamThe Nottingham RHCFCommunity Residences Age Range18-3031-5556+I am retired, or plan to retire in 2021-2022 Affinity Groups An unrestricted donation of $250 or more qualifies you for membership in Women United or Emerging Leaders United. An unrestricted donation of $375 or more qualifies you for membership in both! Join Women UnitedJoin Emerging LeadersJoin Both Affinity Groups Step Up Challenge Increasing your donation by $1 per week qualifies you to take the Step Up Challenge! This will make you eligible for all of the weekly prizes and $3,000 quarterly grand prizes.* I am taking the Step Up Challenge *Donation not required to enter. Alternative entry available on our website: unitedway-cny.org. United Way has not provided any goods or services in exchange for these gifts. Pledge Information Payroll Deduction Donation Amount Per Pay Period X For a Total Annual Gift of: Bill MeOne-time billingQuarterly billingMonthly billing Please contact me regarding the donation of securitiesCash or check made out to United Way of Central New York Confirmation Signature Date of Signing I wish to remain anonymous Please leave this field empty.