Staff Giving Webform You must have JavaScript enabled to use this form. Staff Donor Information Name Address Address Address 2 City/Town State - None -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code Phone Email Donation Information I'd like to update my previous recurring gift This checkbox is for those who made a recurring gift with no expiration date, who wish to make a change to their gift. If no changes are needed, no action is needed on your part, and we thank you for continuing to support the Y's Impact Fund! I will support the Y's Impact Fund with: - Select -One-time giftRecurring gift Gift Amount $130 $260 $390 $520 $650 Other Enter other... $ Recurring Gift Amount Please enter the amount that you will give each pay period or monthly (you'll be able to choose frequency further down in this form). $5 $10 $15 $20 $25 Other Enter other... $ If your recurring gift of $5 is made bi-weeklythrough payroll deduction or other payment method, you will donate $130/year.If your recurring gift of $5 is made monthly though credit card or bank account, you will donate $60/year. If your recurring gift of $10 is made bi-weekly through payroll deduction or other payment method, you will donate $260/year.If your recurring gift of $10 is made monthly though credit card or bank account, you will donate $120/year. If your recurring gift of $15 is made bi-weekly through payroll deduction or other payment method, you will donate $390/year.If your recurring gift of $15 is made monthly though credit card or bank account, you will donate $180/year. If your recurring gift of $20 is made bi-weekly through payroll deduction or other payment method, you will donate $520/year.If your recurring gift of $20 is made monthly though credit card or bank account, you will donate $240/year. If your recurring gift of $25 is made bi-weekly through payroll deduction or other payment method, you will donate $650/year.If your recurring gift of $25 is made monthly though credit card or bank account, you will donate $300/year. To calculate how much you will give in a year:If donating bi-weekly through payroll deduction or other payment method, multiply the amount you entered times 26.If donating monthly through credit card or bank account, multiply the amount you entered times 12.Example: If your recurring gift amount is $50, you will give $1,300/year if using payroll deduction (bi-weekly) My gift will support the location selected below: - Select -Albemarle Family YMCABlocker Norfolk Family YMCACurrituck Family YMCAEastern Shore Family YMCAEffingham Street Family YMCAGreat Bridge/Hickory Family YMCAGreenbrier Family YMCAGreenbrier North YMCAFirst Tee — Hampton RoadsHilltop Family YMCAIndian River Family YMCAJames L. Camp Jr. Family YMCAMt. Trashmore Family YMCANorthampton County YMCAOuter Banks Family YMCAPrincess Anne Family YMCASuffolk Family YMCATaylor Bend Family YMCAYMCA at EdinburghYMCA at JT's Camp GromYMCA Camp Silver BeachYMCA of PortsmouthYMCA of South Boston/Halifax CountyYMCA on GranbyYMCA of South Hampton Roads Home OfficeI would like my gift to support more than one location. I would like my gift to equally support the following locations Albemarle Family YMCA Blocker Norfolk Family YMCA Currituck Family YMCA Eastern Shore Family YMCA Effingham Street Family YMCA First Tee — Hampton Roads Great Bridge/Hickory Family YMCA Greenbrier Family YMCA Hilltop Family YMCA Indian River Family YMCa James L. Camp Jr. Family YMCA Mt. Trashmore Family YMCA Northampton County YMCA Outer Banks Family YMCA Princess Anne Family YMCA Suffolk Family YMCA Taylor Bend Family YMCA YMCA at Edinburgh YMCA at JT's Camp Grom YMCA Camp Silver Beach YMCA of Portsmouth YMCA of South Boston/Halifax County YMCA of South Hampton Roads YMCA on Granby Please recognize my gift as: I prefer to remain anonymous Payment Options Payment Options - Select -I wish to give through payroll deductionContact me for payment information Payment Options - Select -I wish to give through payroll deductionI wish to set up recurring payments from a bank account or credit card Payment Frequency - Select -MonthlyBi-Weekly Deduction Date Please select a Tuesday pay date starting January 7, 2025 or later. Deduction Start Date Please select a Tuesday pay date of January 7, 2025 or later. Recurring Gift Start Date Please select a start date of January 7, 2025 or later. I authorize ongoing deductions from my paycheck until I notify the YMCA to end my contribution. I authorize payments from the payment method I provide until I notify the YMCA to end my contribution. Signature By signing above, I agree to donate the amount entered to support annual giving at the Y.
