Brookhaven National Laboratory Campaign Pledge Form

Note: To make a one-time donation by credit or debit card, please click HERE.

Payroll Contribution

I want to contribute the following amount each pay period via payroll contribution.
To be a Leadership Supporter in 2025, your total contribution must equal $1,000 or more.

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Choose your designation(s) from the list below by typing the percentage of your total contribution you would like allocated.

Percentages must total 100%.

Please type the name of your designated 501(c)(3) community partner agency here. For a list of United Way of Long Island’s community partner agencies visit www.unitedwayli.org/communitypartners.
Agreement
My signature below, confirms my payroll deduction request as stated above.

United Way of Long Island's most recent financial reports are accessible at www.unitedwayli.org/aboutus/financial-information. And, the New York State Office of the Attorney General may be contacted at 212.416.8401, or by visiting www.charitiesnys.com, if necessary.

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