Retirees
Fill out and submit this page to stay connected to your local United Way St. Croix Valley as a retiree. We are excited to continue to partner with you and appreciate all your support.
 
1.
Contact Information:

First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

2.

Retired from (Company Name): 

 

50 characters left.
3.

Would you like to be added to our monthly e-newsletter? 

Yes
No
4.

Have you donated to United Way for 10+ years? 

Yes
No
5.

Comments:

 

350 characters left.