Benjamin Logan Schools 2023 Pledge Form

YES! I will join the fight for the health, education, and

financial stability of every person in our community!

I will make the following payroll deduction pledge.

If you wish to make your gift via Credit Card, click here.

Gifts made via cash or check may be given to Sally Stolly.

All staff making a payroll deduction gift of $250 or more will be entered into a drawing for one of the prizes listed below. Your number of entries in the drawing will equal your per pay donation.

Photography Session - The Photo Booth ($225 value)
$50 Logan County Chamber Choice Certificates (10x)

All staff making a payroll deduction gift of $125 or more will be entered into a drawing for one of the prizes listed below. Your number of entries in the drawing will equal your per pay donation.

$25 Gift Card - The Craft Emporium (2x)
$25 Mastercard Gift Card - donated by Middlefield Banking Company (6x)

All staff making a payroll deduction gift of any amount will be entered into a drawing for one of the prizes listed below. Your number of entries in the drawing will equal your per pay donation.

$25 Gift Card - The Chefhouse (2x)
Ackley's Pure Maple Syrup - Half Gallon

* How much do you wish to donate per pay in 2024? (Deductions start in January, 2024 for a total of 25 pay periods.)

$20 / pay for a total gift of $500

$15 / pay for a total gift of $375

$10 / pay for a total gift of $250

$5 / pay for a total gift of $125

OTHER: $_____ / pay. Enter per-pay amount below.

1-TIME PAYROLL DEDUCTION. Enter total gift below. (To be deducted from 3rd pay in January)

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OPTIONAL: Do you wish to designate your gift to one or more specific United Way programs? If so, type the name(s) of the program below. For a list of United Way-supported programs, click the PROGRAM DIRECTORY link below.

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UNITED WAY PROGRAM DIRECTORY

* First Name

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* Last Name

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* E-mail

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* Address

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* City

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* Zip Code

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* In which building do you work?

Elementary

Middle School

High School

Central Office

Transportation Department

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