Employee Giving – Payroll Deduction Form

2018 Bridgeport Hospital Employee Giving Pledge Form

I believe that our Hospital is vitally important to our community and I am proud to commit a donation in support of the Bridgeport Hospital Giving Campaign. Please complete the form below and press SUBMIT when done.

Donation Information

Total Amount of Designated Fund gifts - Enter below first

Employee Name and Address

My gift will be designated to: (Please enter donation amount for each designation. You may choose more than one)

Enter amount:
Enter amount:
Enter amount:

United Way Gift:

I would like to give to The United Way to support our community. Click the link below to make a donation online:
User ID: Bpthosp Password: 06610


Tribute Gifts

Name to notify
Tribute Notify Address:

Thank you for your generous support! - Please check the box above to provide your signature


Raffle Prizes to be awarded (minimum gifts of $100 and $250 required for eligibility)

Click on the gallery of prizes to view each in detail

Thank you for supporting Bridgeport Hospital Employee Giving Campaign!