Better Together Pledge Form |

Employee Information

Please fill out all sections. Please provide a mailing address so that we can send you a tax acknowledgement letter for your records.

Name*

First M.I. Last

Campus*

Home Address*

Street Address Address Line 2 City State ZIP Code

Email

Phone

Giving to Support Sun Health's Nonprofit Mission

Payroll deductions for this campaign will begin with the second paycheck received in January.

Payroll Deduction

$ 25 per pay period
$ 15 per pay period
$ 10 per pay period
$ 5 per pay period
Custom Amount
One time payroll deduction

Amount to contribute per pay period

One-time payroll deduction of:

Please enter a number greater than or equal to 10.

(minimum $10)

YES! Please automatically renew my pledge every year. You can cancel or update this at any time by contacting your HR representative.

Allocate 100% of your contribution to a single fund OR, using percentages, divide it among no more than 2 funds.
If no designation is indicated, your donation will be allocated to the General Fund for use in the areas of greatest need.

General Funds/Area of Greatest Need

Employee Association (03AF)
Sun Health Foundation Greatest Need (03GE)
Sun Health Community Health and Wellness Programs (04CS)
Emergency Department at Banner Boswell (00ER)
Robotic Technology for Cancer at Banner Boswell Medical Center
Banner Boswell Medical Center Greatest Need (00GE)
Banner Del E. Webb Medical Center Greatest Need (02GE)
Robotic Technology for Cancer at Banner Boswell Medical Center (07ON)
Other (please specify)

% to Employee Association (03AF)