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United Way of Central Illinois Logo

Annual Meeting and Celebration Registration

For tables and groups registering by phone, please call: 217-726-7000.

First Name

Last Name

Company Name

Phone

Address

City

State

Zip

Dietary restrictions (Booking a table, United Way Staff will contact you)

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Card Number

Expiration Date

CVV

I would like to cover the payment processing fee.

Donor hereby approves the payment of the charitable donation and/or purchase to United Way of Central Illinois and in the amount set forth herein.