Employee Giving – Payroll Deduction Form

2019 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.

Employee Information

Employee Name and Address

Donation Information

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:
Enter amount:
Total Amount of Designated Fund gifts - Enter above first

Tribute Gifts

Name to notify
Tribute Notify Address:
City
State/Province
Zip/Postal

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

Sending

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

Thank you for supporting Bridgeport Hospital Employee Giving Campaign!