Employee Campaign Donation Form

Please fill out the form below to donate funds to the NHRMC Employee Campaign through payroll deduct, or PDO donation. An acknowledgement receipt will be mailed to your home.

If you currently have an ongoing Employee Campaign payroll deduction, your donation will continue and there is no need to complete the form below.

Want to make a change to your ongoing donation? Please email stephania.bloodworth@nhrmc.org.

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(if different from above)
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(This is not your badge number)
(This amount will be deducted from each pay period)
(This amount will be deducted from each pay period)
Please designate my funds to the following areas (Limit 2).