Drawing Entry Form

I supported the United Way with my donation of...
-- Select Your Donation Level -- $3.00 Per Week $2.00 Per Week $1.00 Per Week 16 Hours of Service 8 Hours of Service 4 Hours of Service

• Donors pledging $3.00 per week or more to the United Way OR volunteering 16 hours to an approved community project will be entered into the drawing for a room full of furniture and accessories up to $3,000 value (not including appliances or electronics). A wonderful "Thank You!" supplied by our friends at Olums. Entering this drawing will automatically enter you into the lower level drawings!
• Donors pledging $2.00 per week or more or volunteering 8 hours or more to an approved project will be entered into the drawing for a $1,500 Gas Giveaway from our friends at Manley's Mighty Mart. Entering this drawing will automatically enter you into the $1.00 / 4 hour drawing!
• Donors pledging $1.00 per week or more or volunteering 4 hours or more to an approved project will be entered into the drawing for $1,000 in Groceries from our friends at Wegmans.

Please complete all fields in the form below and click "Submit Form" to enter the drawing!

First Name
Last Name
Address
City		State		Zip
Phone
Email