Community Campaign - Payroll Deduction

Community Campaign - Payroll Deduction

If you have any questions, please contact Sharline Doss at or x3896

Employee ID Number:
First Name:
Last Name:
Partner/Spouse Name (if applicable):
Please deduct my gift in equal installments of $
Please continue this deduction...

If you selected that you would like to continue this deduction until you have reached a specific contribution amount, please indicate that amount here:
I would like to designate my contribution to the following:

If you wish to support a area not listed above please indicate it here:
Please contact me about having this gift matched through my spouse/partner's company
I wish my gift to remain anonymous

This information is collected under the authority of the Wilfrid Laurier University Act for the purposes of processing your donation, keeping you informed of our programs and services, and for fundraising for Wilfrid Laurier University. Any information we receive from you will be kept private. We will not sell, rent or trade your information with anyone outside Wilfrid Laurier University. If you have any questions about how we use your information, please contact Duncan Malcolm, Director: Advancement Services, at or 519.884.0710 ext. 3866.