Campaign to Change What It Means To Be Blind

Campaign to Change What It Means To Be Blind

The Campaign To Change What It Means To Be Blind Capital

Campaign Pledge Intention

Name: _____________________________________________________

Home Address: __________________________________________________

City, State, and Zip: __________________________________________________

Home Phone: ____________________________ Work Phone: __________________________

E-mail address: ________________________________________

Employer: ___________________________________________

Work Address: _______________________________________________

City, State, Zip: ________________________________________________________

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To support the priorities of the Campaign, I (we) pledge the sum of $___________.

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My (our) pledge will be payable in installments of $ __________ over the next

____ years (we encourage pledges paid over 5 years), beginning _____________,

on the following schedule (check one): __ annually, __ semi-annually, __ quarterly,

__ monthly

I (we) have enclosed a down payment of $ ________________

___ Gift of stock: _____________________ shares of _____________

___ My employer will match my gift.

Please list (my) our names in all Campaign Reports and on the Campaign Wall

of Honor in the appropriate Giving Circle as follows:

__ I (We) wish to remain anonymous.

Signed: ________________________________ Date: __________________

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