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Schedule A Loaned Campaign Representative 
2013 Loaned Campaign Representatives (LCRs) are available beginning July 31 to speak to your employees about United Way and the life changing work we do in partnership with 23 participating organizations and numerous partners across the community. Their presentations can fit any time-frame and audience requirements. Presentations may be scheduled seven days a week, any hour of the day. 
Please allow at least three business days for scheduling requests.
To schedule a presentation please complete form below or contact Erin Hallett by email at ehallett@uw.lafayette.in.us or by phone: 765-742-9077 x241

 1.  Presentation Date/Time

 2.  Presentation Date/Time

 3.  Presentation Date/Time    

 4.  Presentation Date/Time  

 5.  Presentation Date/Time 

 6.  Presentation Date/Time 

 7.  Presentation Date/Time 

 8.  Presentation Date/Time 

 9.  Presentation Date/Time

10. Presentation Date/Time  

Address of Company
Specific Location of Presentation at Company
Phone #
In-House Campaign Coordinator(s) Name(s)
Person Requesting LCR/Contact Person at Site
Timeframe for Presentation
Place on Agenda
Audience Make-up and Size
Electronic Medium Available 
Are Campaign Supplies Needed?
2012 $ Raised
# of Vanguards in Company
Additional considerations
Do you need Spanish Language pledge forms or a Spanish speaking LCR?
New Goal
E-News Sign Up:

Please provide dates and times for each Loaned Campaign Representative presentation your are requesting for your organization. It is not necessary to provide alternative dates on this form. 
Yes, we need Spanish pledge formsYes, we need a Spanish speaking LCRNo