1. Fill in first and last name, sixdigit employee number and
department name. Use the
worksheet at the bottom of
the form to calculate your 1
percent amount.
Beyond contributor, your total
per-paycheck amount must be
equal to or greater than your 1
percent amount. For one-time
deductions, cash or checks,
your yearly total must be
equal to or greater than your 1
percent amount times 24.
or more of my pay” if your
contributions equal 1 percent
or more of your salary.
7. Select an option for an
acknowledgement. If you
choose yes, write in your
email address. Write clearly
2. Choose a contribution type:
and legibly, agencies will
Per-paycheck sign-up
Contribution (24 times per form
5. Calculate Contribution sign-up form
your totals. For percontact you via email.
year), one-time deduction,
Name: ___________________________________ paycheck, multiply by 24 to
cash, check made out to
Contribution sign-up and date the form.
8. Sign form
Name: ___________________________________
get the yearly total.
agency or check made out to
Contribution sign-up form
Employee ID: ______________________________
Name: ___________________________________ of the form for
CMC.
9. Make a copy
6. Check yes Employee ID: ______________________________
next to “I would
Contribution Name: ___________________________________
sign-upyour records. Turn in the form
form
Dept: ____________________________________ like toEmployee ID: ______________________________
be an Above & Beyond
3. Fill in agency codes and
to your CMC coordinator.
Name: ___________________________________
by giving 1 percent ID: ______________________________
names per paycheck*: ______________ contributor Dept: ____________________________________
Employee
1% Contribution for your charities.
Dept: ____________________________________
Employee ID:Contribution per paycheck*: ______________
1% ______________________________
Dept: ____________________________________
One time deduction each Cash
1% Contribution per paycheck*: ______________
toCombinedto
give Municipal agency.2014you
Campaign If
1
Dept: ____________________________________
One timeContribution sign-up form
deduction
Cash
Per
agency would Contribution Type:to CMC paycheck (24x)
Check/M.O. made out
Contribution
like to be an Above and
1% Contribution per paycheck*: ______________
Attach Cash, Check or Combined Municipal Campaign 2014
Check/M.O. made out to agency
Contribution Type:
One time deductionCheck/M.O. made out to CMC
Cash
Per paycheck (24x) 1% Contribution perName: ___________________________________
Money Order (M.O.)
paycheck*: ______________
Combined Municipal Campaign 2014
Name: ________________
Contribution sign-up form Check/M.O. made out to CMC
Attach Cash, Check or
Amountmade out to agency
Check/M.O.
Contribution Type:
One time deduction
Cash
Per paycheck (24x)
Money Order (M.O.)
Attach Cash, Check or
Agency Code
Agency Name
Amount out to CMC
Contribution Type:
One time deduction
Cash
Per paycheck (24x)
Name: ___________________________________ out to agencyID: ______________________________
$
Check/M.O. made Employee
Check/M.O. madeEmployee ID: __________
4. Enter in the amount you wish
Combined Municipal Campaign 2014
Attach Cash,Codeor
Agency Check
Money Order (M.O.)
Money Order (M.O.)
Agency Name made out to agency Contribution made out to CMC Amount
Check/M.O.
Check/M.O. sign-up form
$
Dept: ____________________________________
$
Employee ID: ______________________________
3
Dept: _________________
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