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Trident United Way Campaign Form Please circle:  CFC     MUSC    UMA*     MUHA  Dr./Mr./Mrs./Ms.:___________________________________Home Phone:_________________________  SS#:______________________Unit__________________Work Phone:___________  Home Address:_______________________________________________________________  City:_________________________________State:____________Zip:_____________  * UMA employees are eligible for a straight dollar-for-dollar match for all gifts between the amounts of $250 and $500. Call 792-1973 for more information. YES! I want to make a difference with my community care gift!    Payroll Deduction: I authorize my employer to deduct the following amount per pay period: Please check the appropriate box  2% of my pay  1% of my pay  1 hour's pay per month  $100  $50  $25  $10  Other (Please specify) $________ My pay period is:  ___Every two weeks   ___Monthly  Signature:___________________________________________________Date:_________________________        I understand that my gift will continue until modified by me I wish to contribute $_________  ___Cash    _____Check (Check payable to Trident United Way) ______Stock (A Trident United Way representative will contact me) ______By Credit Card: Type_____________ Number ____________________________Exp. Date_________ Please bill my credit card: annually____   semi-annually____   quarterly _____     one time on_______ _____I wish to utilize my UMA Matching Gift option. Total gift including match is $___________ _____My gift of $1,000 or more qualifies me for membership in the Palmetto Society. Please list me in the Palmetto Society roster as _________________________________________________ Thank You  For information call 792-1973. Fax pledge form to 792-8934 or campus mail to TUW/Office of Development, 21D Ehrhardt St., P.O. Box 250182.