Payroll Deduction FormThe Tuomey Foundation Giving Campaign – 2025 The Tuomey Foundation Team Member Payroll Deduction Authorization FormName * Name First First Last Last Employee ID # * Phone Department * Street address * City * State * Zip code * Email * Choose your payroll deduction amount * $2 per pay period $5 per pay period $10 per pay period $20 per pay period $50 per pay period $80 per pay period Other* Other amount * Designation * Area of Greatest NeedCancer ServicesCardiac ServicesDr. & Mrs. Wendell M. Levi Nursing ScholarshipDr. Charles H. White, Sr. Cardiac EndowmentHospice ServicesJeanne C. Watson Oncology EndowmentPrisma Health Tuomey Team Member ScholarshipSumter County Safe KidsWomen, Children, & Infant ServicesOther (please specify) Other designation * Agree to Terms and Conditions * Yes, I AgreeI authorize payroll deduction in the amount indicated per pay period as my gift to the Prisma Health Team Member Giving Campaign. I understand that at any time, I can raise, lower, or cancel my contribution by notifying The Tuomey Foundation via email or in writing. Signature * Date * Captcha Submit If you are human, leave this field blank.
