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Loaned Executive Commitment Form

If your organization would like to support United Way by providing Loaned Executive(s) during the August 9 - December 10, 2010 session, or if you would like to sponsor a qualified individual, please complete the following form. (You will receive an invoice for your contribution/sponsorship.)

* required information


Contact Information
First Name:*
Last Name:*
Job Title:
Company Name:*
Email:*
Phone:*
Address Line 1:
Address Line 2:
City:
State:
ZIP/Postal Code:

Sponsorship and Loaned Executive Information
Please list the name, title and phone for up to three individuals who are interested in Loaned Executive positions
Name 1:
Title 1:
Phone 1:
Name 2:
Title 2:
Phone 2:
Name 3:
Title 3:
Phone 3:
We would like to help defray the cost of the program with a contribution:	$
We would like to support United Way by providing grant income to sponsor an individual to participate in the LE Program:	$5,000 $7,500 $11,500