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N with third parties. Employee ID Number (if not pre-printed above) First Name: MI: Last Name: Home Address: Phone: ( City: ST: ) ZIP: IU Department (If giving through employee campaign): SIGNATURE (My signature authorizes my pledge): Personal E-mail: I WANT TO TRANSFORM LIVES AND CREATE OPPORTUNITY. I am donating to the Community Action Fund, which supports priority projects and partner agencies. My dollars go where they are needed the most and will have the greatest impact. Yes,.

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