Employee Giving

In support of You, Me & BRG Employee Giving
Program, I would like to make the following
pledge:

Note: Deductions will begin June 6, 2014 and end May 29, 2015.


I want to join Club 26! (Club 26: 1 hour of pay for 26 pay periods, must enroll by May 31, 2014)

I would like the following amount to be deducted for 26 pay periods:
$20
$10
$5
Other
(minimum of $1.00)


I authorize General Health System to deduct the amount selected above from my paycheck every pay period starting June 6, 2014. The elected amount of my deduction will be sent confidentially to the Foundation each pay period. This deduction will continue for 26 pay periods or until I notify GHS Payroll Department to discontinue.

$200
$100
$50
$25
Other

* Required





Note: Donors will be recognized by first and last name as entered above.







Full-Time Employee
Part-Time Employee
PRN

Bluebonnet
Mid City
Plaza
Other


Payroll Deduction
Credit Card
Name and address same as above










Check
Please make payable to "Baton Rouge General Foundation".
Make my donation anonymous


Amount

$0


DirectDebt
Credit Card
Cheque

BLUEBONNET

Address:8585 Picardy Avenue
Baton Rouge, LA, 70809
(225) 763-4000

MID CITY

Address:3600 Florida Boulevard
Baton Rouge, LA, 70806
(225) 387-7000