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2023-24 Campaign Pledge Form
Email
Employer Name
Avera
BankWest
Delta Dental
First National Bank
Pierre School District
State of South Dakota
Other
Other
First name
Last name
Employee Number (Enter 0 if you do not have one)
Street Address
Street Address Line 2
City
Region/State/Province
Postal / Zip code
Country
Country
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Primary Phone Number
I would like to pledge a total of $ for the 2023-2024 Campaign:
I would like to fulfill my plege:
As a one time payroll deduction
Via payroll deduction over 24 pay periods
As a one time check/cash gift. (Send to P.O. Box 1111 Pierre, SD 57501
As a one time credit card payment
Please select any/all that appy:
CHAMP giver (donating at least one hour of pay each month
Evergreen Giver (I'd like my gift to renew annually)
LEADERSHIP Giver of $500+
LEADERSHIP Giver of $1000+
None of the above
For LEADERSHIP Giving, please combine with my spouse (List Spouse and Employer Name)
I wish my gift to be anonymous ( Please note: If you choose this option, you will not show up on any listings, even if you are a CHAMP or LEADERSHIP Giver)
No
Yes
I would like a thank you to be sent via
Mail
Email
No Thank You Needed
Please enter your full first and last name to virtually verify your signature.
Submit
Thank you!
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