Annual Affirmation Page

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2013 Affirmation Form

2013 Annual Budget Drive
It Takes a Congregation

Community Unitarian Universalist Church is both an important part of your life and a valued resource in the wider community. Your financial contribution does more than pay the bills. It is an investment in the light of truth, the warmth of community, and the fire of commitment.

*=required field

Donor First Name:*
Donor Last Name:*
Second Donor First Name:
Second Donor Last Name:

Best Telephone:*
Best Email Address:*

I/we commit the following total annual amount to support the operating budget for the 2013-2014 fiscal year (beginning June 1, 2013): (enter amount in box below)

Total Annual Amount:*

Use the following schedule for my/our commitment:*
First Payment Month:*

I/we will pay via:*

Additional Information:	Please contact me to schedule a visit. I am not able to make an annual commitment at this time. I do not wish to make an annual commitment but plan to contribute in the future.

Membership Affirmation:*	I wish to retain my status as a (select one below) I wish to change my status to (select one below)


Signature: /s/ (print name(s))*

If your circumstances change over the course of the upcoming year and you would like to revise your financial commitment or method of payment, please notify the Treasurer. Make sure to complete your 2012-2013 pledge. Write '2012-2013 Pledge' or '2013-2014 Pledge' on the info line of your check to ensure that it is credited to the correct fiscal year.

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