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Questions that require an answer are marked with  *
   
* First Name
   
   
* Last Name
   
   
* Employee #
   
   
* Address
   
   
* City
   
   
* Zip
   
   
* Department
   
   
* Campus
   
   
* Shift
   
   
* Phone Type
   
   
* Phone Number
   
   
* Email
   
   
Recurring Gift
   
   
* Levels of Giving
   
   
Must be a full-time or part-time employee.

Your gift will be automatically calculated for you.
   
   
SELECT ONE: Automatic Payroll Deduction Amount (minimum $5) per pay period
   
Other:
   
One-Time Payroll Deduction Amount (minimum of $25)
   
   
PTO Donation - Semi-Annually (Must have minimum 80hrs in PTO account)
   
   
PTO Donation - One-Time (Must have minimum 80hrs in PTO account)
   
   
* I want my gift to support:
   
   
Unless designated as a recurring gift, all automatic payroll deductions will begin January 2024 and continue for 26 pay periods.

Note: Gifts not designated to a specific project will be put to the Mercy Patient Care Tower general fund.
   
   
Person who encouraged or inspired me to join Spirit of Giving:
   
   
* Signature (type your name in the box below)
   
   
* Today's Date
   
 Choose a date
   
* By Checking ‘I Accept’ you are agreeing to all terms and conditions that have been provided.
   
     

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