Team Member Giving Pledge Form – Baptist Health Foundation

The Baptist Health Foundation is the best place to give. Through the generosity of our team members, the Baptist Health Foundation is able to provide life changing programs in our communities and enhance the work environment of our fellow team members all while sharing faith-based healthcare.

First Name (on payroll) *

Last Name (on payroll) *

Orlando Health Email *

Department

OH Team Member ID *

Team Member Location

Other Location:

Donation Per Pay Period Amount

$5
$10
$20
Other (please specify below)

This donation is ONGOING each pay period (until I contact BHF to make any changes, or I leave Baptist Health)

Other Donation Amount Per Pay Period

This donation is ONGOING each pay period (until I contact BHF to make any changes, or I leave Baptist Health)

One-time Payroll Deduction Amount

Check all you wish to support; donation will be divided evenly

Where the need is greatest at my hospital
Patient Assistance Fund
Team Member Benevolence Fund

Mailing address for tax donation receipt

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Digital Signature (Full Name)

By completing this pledge card I am authorizing Baptist Health Foundation to make a deduction from my paycheck starting in approximately 2-3 pay periods.

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