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Schedule A Loaned Campaign Representative 
2012 Loaned Campaign Representatives (LCRs) are available beginning July 16 to speak to your employees about United Way and the services of the 23 participating organizations.  Their presentations can fit any timeframe and audience requirements. Presentations may be scheduled seven days a week, any hour of the day.  
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  


Company
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?
2011 $ Raised
# of Vanguards in Company
Special Considerations:
Do you need Spanish Language pledge forms or a translator?
New Goal
E-News Sign Up:
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Email
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. 
USBDVDVHSNONE
YesNo
Yes, we need pledge formsYes, we need a translatorNo