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Regional Foundation
2012 Employee Campaign Pledge Card
Employee Number:
*
must be 5 digits
First Name:
*
Last Name:
*
Email Address:
*
not a valid email
Department Number
(00-0000)
:
*
must be in format 00-0000
Department Name:
*
Please select a Gift Level:
*
One Time Gift
A donation of $40.00 or greater is required to receive incentive
Diamond Club Level
26 hours per year
Signature Club Level
52 hours per year
Society of 1921 Annual Donor
Gift of $1,250 in one calendar year required for gala reservations
Society of 1921 Chairman's Circle
Pledge of $10,000 over 8 years
Gift of $1,250 in one calendar year required for gala reservations
Please select your contribution details:
*
New Chairman Circle
Current Chairman Circle
Continue current method of giving
Change method of giving
Cash
Check
Payroll Deduction
Current PTO
Future PTO
Amount:
*
Choose a T-Shirt Size:
S
M
L
XL
*
Designate your Primary donation fund:
Employee Wellness Program
Access Health Spartanburg
Alexander Lee Seigler NICU Education Fund
Bariatric Fund
Bearden-Josey Center for Breast Health Fund
Behavioral Health Fund
Betty Ann Moore Colon Cancer Fund
Birth Matters
Bradshaw Pediatric Rehab Assistance Fund
Cancer Breast Health
Cancer Endowed Chairs
Cancer Professional Development/Education
Cancer Services
Cancer Special Needs Fund
Cancer Special Project Fund
Cancer Survivors Day
Cardiac Rehab Special Needs Scholarship Program
Cardiology Consultants Education and Staff Support Fund
Center for Health and Healing
Chaplain's Fund
Chaplaincy Intern Scholarship Fund
Cleft Palate Fund
Cleveland Park Train Accident Fund
Community CPR
Community Outreach
Congestive Heart Failure Program
Congregational Nursing
Dan Williamson Education Fund
David S. "JR" Bacon, Jr. Mem Forgivable Loan
Diabetes Management Fund
E. Estelle "Pooch" McCraw Nursing Scholarship
Emergency Center Resource Fund
Emergency Medical Svcs
Employee Emergency Fund
Epilepsy
GCC Survivorship
GCC Translational Research
Green Gate Gatehring
Harold E. Fleming, Sr. MD Patient Independence Fund
Harry M. Leyland Memorial Fund
Healing Arts - General Fund
Healing Arts - Hodge
Healthy Smiles
Heart in One
Heart Resouce Center
Heart Services
Home Health
Hospice
Jane A. Bailey Nurse Scholarship Fund
Jo Ann McMillan Endowed Professorship
Lula Spencer Nursing Education Fund
Mammography Assistance
Maternal Fetal Medicine
Missy Rowland Turner Memorial Fund
Mobile Mammography Fund
New OR Expansion and Renovation
NICU/Pediatrics
Nursing Administration Education Fund
Nursing Education
Nursing Research Council
NXT Research
Ob/Gyn Research
Pediatrics Rehab
Rachel Marie Evans Nursing Scholarship
Radiology Continuing Education
Respiratory Outreach
Roberta Hinkle Mem Schol Fund
Robin Murray Scholarship Fund
SAFE KIDS
Senior Care
"Seppy" Fowler Memorial Nurses Education Fund
Sports Medicine
SRMC Laboratory
Stroke Fund
Student Development Programs
Surgical Critical Care Education Fund
Unrestricted
Village At Pelham
Webster Designated (Webster Breast Center Staffing Fund)
Webster Mammo
Where the Need is Greatest
Women's Services
Zerno Martin Nursing Scholarship Fund
Designate a Secondary donation fund (optional):
Employee Wellness Program
Access Health Spartanburg
Alexander Lee Seigler NICU Education Fund
Bariatric Fund
Bearden-Josey Center for Breast Health Fund
Behavioral Health Fund
Betty Ann Moore Colon Cancer Fund
Birth Matters
Bradshaw Pediatric Rehab Assistance Fund
Cancer Breast Health
Cancer Endowed Chairs
Cancer Professional Development/Education
Cancer Services
Cancer Special Needs Fund
Cancer Special Project Fund
Cancer Survivors Day
Cardiac Rehab Special Needs Scholarship Program
Cardiology Consultants Education and Staff Support Fund
Center for Health and Healing
Chaplain's Fund
Chaplaincy Intern Scholarship Fund
Cleft Palate Fund
Cleveland Park Train Accident Fund
Community CPR
Community Outreach
Congestive Heart Failure Program
Congregational Nursing
Dan Williamson Education Fund
David S. "JR" Bacon, Jr. Mem Forgivable Loan
Diabetes Management Fund
E. Estelle "Pooch" McCraw Nursing Scholarship
Emergency Center Resource Fund
Emergency Medical Svcs
Employee Emergency Fund
Epilepsy
GCC Survivorship
GCC Translational Research
Green Gate Gatehring
Harold E. Fleming, Sr. MD Patient Independence Fund
Harry M. Leyland Memorial Fund
Healing Arts - General Fund
Healing Arts - Hodge
Healthy Smiles
Heart in One
Heart Resouce Center
Heart Services
Home Health
Hospice
Jane A. Bailey Nurse Scholarship Fund
Jo Ann McMillan Endowed Professorship
Lula Spencer Nursing Education Fund
Mammography Assistance
Maternal Fetal Medicine
Missy Rowland Turner Memorial Fund
Mobile Mammography Fund
New OR Expansion and Renovation
NICU/Pediatrics
Nursing Administration Education Fund
Nursing Education
Nursing Research Council
NXT Research
Ob/Gyn Research
Pediatrics Rehab
Rachel Marie Evans Nursing Scholarship
Radiology Continuing Education
Respiratory Outreach
Roberta Hinkle Mem Schol Fund
Robin Murray Scholarship Fund
SAFE KIDS
Senior Care
"Seppy" Fowler Memorial Nurses Education Fund
Sports Medicine
SRMC Laboratory
Stroke Fund
Student Development Programs
Surgical Critical Care Education Fund
Unrestricted
Village At Pelham
Webster Designated (Webster Breast Center Staffing Fund)
Webster Mammo
Where the Need is Greatest
Women's Services
Zerno Martin Nursing Scholarship Fund
NOTE: If a donation fund selection is not made, gifts will go where the need is greatest.
Diamond Club level and above, please list your name as you would like it to appear on our employee donor wall:
Please provide your current mailing address in the space provided below. We also welcome your comments:
I would like to be notified when I am about to max out on PTO hours
Please check here if you do NOT want us to use your photo in Foundation promotions.
Please enter the words you see below and click submit.
As a 501(c)3 organization, a gift to the SRHS Foundation is fully tax deductible.
Spartanburg Regional Healthcare System Foundation
101 East Wood Street • Spartanburg, SC 29303 • 864-560-6727
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Spartanburg Regional Healthcare System