Lee Memorial Health Systems

RX Games Registration

Get in the game for a better Lee Memorial Health System! Make a pledge and support your TEAM today!

   

2015 RX GAMES Funds:
 

I would like my gift to benefit one of the following (please check One box):

Cape Coral Hospital
Golisano Children's Hospital Campaign
Gulf Coast Medical Center
HealthPark Medical Center
Lee Memorial Hospital
Lee Physician Group
Outpatient Services

 

Gifts Through Employee Payroll Deduction
  I authorize Lee Memorial Health System Foundation to deduct the following amount from my pay, beginning
July 2015.
 

$1 / per pay period = $26.00
$2 / per pay period = $52.00
$5 / per pay period = $130.00*
$10 / per pay period = $260.00
$20 / per pay period = $520.00
$50 / per pay period = $1,300.00
$100 / per pay period = $2,600.00
$150 / per pay period = $3,900.00
 

One time gift of $ through payroll deduction.

*Giving at this level enters you in Super Grand Prize Drawing!

Donor Name:
(as it should appear for recognition)

First:

Last:

Street Address:

Address 2:

City:

State:

Zip Code:

Email:

Employee ID#:

Department:

Campus:

Cost Center:
(see the back of your ID badge)

Date:

My gift is:


 

Name of Person:

  Please notify:  

  Name:

  Address:

  City:

  State:

  Zip:

   
   

Important: Please do not submit credit card information through this non-secure form.

If you would like to make a one-time donation through credit card or check, or if you have any questions, please call Duane Higgins at 239-343-6078 or email at Duane.Higgins@LeeMemorial.org.

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