The Tri-City Hospital Foundation Employee Giving Program utilizes funds donated by employees of Tri-City Medical Center to equip different departments with vital medical instruments, supplies or even to bring a monumental project to life. We deeply thank all of you who choose to support this place that serves the people who need us most.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

TCMC Phone Extension

TCMC Email

Department

TCMC Employee ID#

Amount you would like to give per pay period

$

Would you like to use Payroll Deduction?

Authorization

I personally authorize TCMC to make payroll deductions in the specified amount every pay period. I further authorize TCMC to begin these deductions on the next pay cycle.

Yes

No

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