2023 Employee and Volunteer Gifts Campaign Name(Required) First Last Email(Required) Department(Required) Date(Required) MM slash DD slash YYYY Employee No.(Required)My Method of PaymentI want to join the flock with payment from:(Required)Payroll DeductionCredit Card or Direct DebitCheckPayroll Deduction: Please enter the amount of money you'd like deducted from the number of pay periods for a total donation amount.Dollar AmountNumber of Pay PeriodsTotal Donation Amount Add RemoveExample - Deduct $5 from my paycheck over the next 26 pay periods for a total donation of $130. Deductions will begin mid-September 2023.I want this to be a recurring gift as my commitment to providing ongoing support(Required) Yes No Changes to or questions about recurring gifts can be directed to Ben Craig at bxcraig1@sentara.comCredit Card or Direct Debit Credit Card or Direct Debit To charge your credit card or process a direct debit (e-check) from your bank account, please visit our secure online donation page Check Payment Check For check payment, please make your check payable to the RMH Foundation and mail through interoffice mail or mail to 2010 Health Campus Drive, Harrisonburg, VA 22801.What My Gift Will SupportChoose where to designate your gift:(Required) Employee Relief Fund: Helping our own team members in a time of need RMH Priority Fund: Wherever the need is greatest. To benefit the following SRMH department (signify immediately below) Designate my gift to a specific department or program:
