Form – Give To St. Peters Hospital

Healing Holidays

Price:

Payroll deduction of $1,000 will be paid over 5 pay periods ending 2024.

Grand Raffle Tickets

Price: $50.00

Organization/Department Name

Printed Name*

Please print your name as you wish to appear on our printed materials for our Honorary Committee.

Name*

First Last

Email*

Phone*

Workday ID No*

Address*

Street Address City State ZIP Code

Guest Information

Name	Email

Comments / Special Requests

Acceptence*

I agree to allow SPHP to make bi-weekly deductions from my paycheck totaling $1,000.

Signature*

Total:

$0.00

Phone

This field is for validation purposes and should be left unchanged.