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U2K Campaign Organizational Endorsement Form

Please use the form provided below to submit your organization's endorsement and contribution to the U2K campaign. If you would prefer to not send this information over the Internet, please print this page and mail it to us. We will be adding the capacity to accept online credit card donations very soon. Thank you!

We hereby take the U2K Pledge and commit our organization to:

  • use the 2000 elections as the beginning of a sustained effort to ensure comprehensive, quality, affordable and publicly accountable health care for all; and,
  • work with other groups and associations towards this goal.

WE CALL ON ALL CANDIDATES RUNNING FOR OFFICE IN 2000 to commit to making universal health care a top priority in the next legislative session.


Organization Name:

Organization

Type of Organization:

Local/Community
Regional/State
National

Endorsement Level:

Endorser - organization name shared as endorser.
Educator - endorse and commit to educate members and engage candidates.
Networker - endorse, educate members, engage candidates, reach out to other groups to join campaign.
Coordinator -- endorse, educate members, engage candidates, reach out to other groups, give staff/volunteer time to the campaign, give financial support and participate in state level strategizing; eligible to join Campaign Steering Committee.

Endorsement Authorized By:

Name
Title
Contact Person (if different)
Address
Address (cont.)
City
State/Province
Zip/Postal Code
Phone
FAX
E-mail
Web Site

Organizational Donation:

As a grassroots campaign, the U2K Campaign relies heavily on the voluntary contributions of its supporters. Because the U2K Campaign is an educational campaign and does not endorse candidates or legislation, contributions are tax-deductible. Suggested organizational donations are:

Local/Community

$ 25      $ 50     $ 100
Regional/State    $ 50 $ 100  $ 250
National $ 100 $ 500 $ 2,000

Check Sent* (payable to U2K Campaign) $
OR
Pledge $ on our Credit Card (NOTE: for Credit Card donations, please print this form out, and then fill in the credit card account information and mail it in*.)

Charge to MasterCard  Charge to Visa  Charge to AMEX
Account #    Exp. Date:   

We welcome individual donations to support the Campaign too!


*Make checks payable to the "U2K Campaign." Contributions are tax deductible.  

Mail to: U2K Campaign, 2800 Euclid Ave, #520 Cleveland OH  44115-2418

 

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U2K Campaign
2800 Euclid Ave., Suite 520 Cleveland OH 44115-2418         
Tel: 216/902-5577  Fax: 216/241-8423

U2K questions: uhcan@uhcan.org                Website questions u2kwebmaster@loebigink.com