United Way Loyal Donor Registration

Thank you for being a loyal donor of United Way of West Alabama! You LIVE UNITED by giving your hard earned money, by donating your valuable time, and by being an advocate of social service needs in West Alabama.

Please fill in the information below so we can learn a little more about you and keep you updated with what is going on at United Way and our partner service agencies.

When you fill out the information below, you will be registered for your opportunity to receive a free LIVE UNITED t-shirt. No donation required to be eligible. Three entries per month will be chosen at random to receive a free t-shirt.

Please fill out all information below

 

Prefix:	First Name:	Last Name:	Suffix:
Business Name (if any):
Home Address:
City:		State:	Zip:
Phone:
Home Email Address:
Work Email Address:
How many years have you contributed to United Way?
Date of birth:
--Select Month-- January February March April May June July August September October November December    --Select Day-- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    --Select Year-- 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 (Year not required)
Security Code:

 

No goods or services are exchanged in whole or in part for a donation to United Way of West Alabama.