Donation Form

One Time Payroll Deduction
Thank you for participating in the employee giving program! Every dollar of your gift stays local and is an investment in our community
Amount:	One Time Deduction $10.00 One Time Deduction $20.00 One Time Deduction $50.00 One Time Deduction $100.00 One Time Deduction $200.00 Other Amount $     *
I would like to support:	Unrestricted (Area of Greatest Need) Community Health Good Samaritan Tri-Cities Cancer Center Caregiver Campaign Pediatrics Scholarships