Community Campaign - Payroll Deduction

Community Campaign - Payroll Deduction
Employee ID Number:
First Name:
Last Name:
I am a Laurier graduate:
From my pay, please deduct my donation in equal amounts of

Other amount:
Continue this deduction...

Indicate the total contribution amount here:
I would like to designate my contribution to the following:
If OTHER designation is chosen, please specify here:
I wish my gift to remain anonymous
I spoke to a Laurier staff member about this gift:
Staff Member Name:
Appeal Code
I would like to make this gift in honour of someone special
Tribute Type:
This gift is in honour memory of (please provide full name):
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 [email protected] or 519.884.0710 ext. 3866.