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

Field is SUM of Fund amounts entered below

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 link below to make donation online:
Username: bpthosp Password: 06610


Tribute Gifts


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!