Survey

Welcome to your Self-Help Credit Union Workplace Giving Campaign!

EarthShare North Carolina organizations are leading the way to clean up our air and water, protect
wildlife and their habitats, and ensure that we have natural places to visit and enjoy. They are also
educating current and future generations on making decisions that create and maintain healthy
communities. By supporting EarthShare North Carolina organizations, you are taking part in maintaining
a healthy North Carolina for your generation and creating a natural legacy for generations to come.

Donations can be designated to a specific organization(s) or to EarthShare North Carolina to be shared
with all organizations. All donations are tax-deductible to the fullest extent by law and EarthShare
North Carolina certifies that no goods or services were provided as consideration for your contribution.

83.5 cents from every $1 raised goes directly to EarthShare North Carolina organizations -- the
remainder is used to promote our members and educate the general public about the value they bring
to protecting NC’s natural heritage.

To see a list of EarthShare North Carolina member organizations, go back to our homepage and click on
'Who We Support'. To support EarthShare organizations in other states, please visit www.earthshare.org
and click on the 'Who We Support' page for links to other states.

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I authorize my employer to deduct the following amount from my paycheck per pay period:

I authorize my employer to deduct the following amount from my paycheck per pay period: $5

$10

$20

$30

Other Amount

Enter other amount

*
Enter total annual gift (Amount per pay period X # of pay periods per year)

Enter total annual gift (Amount per pay period X # of pay periods per year)

*
I would like my contribution:

I would like my contribution: Distributed amongst all EarthShare North Carolina organizations

Distributed to specific EarthShare North Carolina organizations

Please indicate which specific organizations you would like your gift distributed to:

Please indicate which specific organizations you would like your gift distributed to: Name of Organization #1
Total amount to Organization #1
Name of Organization #2
Total amount to Organization #2
Name of Organization #3
Total amount to Organization #3
Name of Organization #4
Total amount to Organization #4
Name of Organization #5
Total amount to Organization #5

*
Total designations should not exceed your Total Annual Gift listed above

Total designations should not exceed your Total Annual Gift listed above * First and Last Name:
* Street Address:
* City/Town:
* State:
* Zip Code:
* Email Address:

*
I would like to receive acknowledgement of my gift(s).

I would like to receive acknowledgement of my gift(s). Yes

*I authorize my employer to deduct the following amount from my paycheck per pay period:

*Enter total annual gift (Amount per pay period X # of pay periods per year)

*I would like my contribution: