2024 Employee Giving Pledge Form2024 Prisma Health Employee Giving Campaign Name * Name First First Last Last Employee ID # * Phone Street Address * City * State * Zip Code * Email * Choose your payroll deduction amount * $5 per pay period $10 per pay period $20 per pay period $50 per pay period $80 per pay period Other* Other Amount Designation * Area of Greatest NeedCancer InstituteChildren's HospitalWound Healing & Hyperbaric Oxygen CenterCare Fund/Employee Assistance ProgramsHospiceHeart HospitalTrauma ServicesOther* Other Designation Share your story! Why do you give back? Preferred Shirt Size X-SmallSmallMediumLargeX-LargeXX-LargeXXX-LargeXXXX-Large Agree to Terms and Conditions * Yes, I AgreeI authorize a recurring payroll deduction in the amount indicated per pay period as my gift to the Prisma Health Miracle Team employee giving campaign. I understand that at any time, I can raise, lower or cancel my contribution by notifying the foundation via email or in writing. Submit If you are human, leave this field blank.
