Pledges of $1,000 or more per year to any designation can be made for up to five years. Associates contributing $1,000 or more per year will also become members of the Nemours Society and invited to a special event.

Pledges to the Capital Campaign (Expansion) must be paid in full by Dec. 31, 2016

Pledges with a payment duration of 1 year or less must be paid in full by the end of the calendar year in which the pledge was initiated.

* required information

Associate Payroll Deduction Form

 

Contact Information
Please note: Only Associates with full- or part-time employment status may sign up for payroll deduction. If you are an Associate with casual employment status, we are unable to offer payroll deduction.

You must have at least $1 per paycheck deducted in order to sign up for payroll deduction.
Please specify the geographic location where you work:*
Designation of Pledge:*
If you Selected 'Other" please specify:
Overall Pledge Amount:*$
Duration of Your Pledge:* One-time deduction
1 Year
2 Years
3 Years
4 Years
5 Years
Are you Paid Biweekly or Monthly?:* Biweekly
Monthly
Please specify when you would like deductions to begin:* Next possible paycheck
First pay of next year
Employee ID Number**:*
Prefix (Mr., Mrs., Ms. Dr.):*
First Name:
Middle Initial:
Last Name:*
Suffix:
Suffix 1:
Please enter your name as you want it to appear in a donor listing such as an annual report. (e.g. Anita Smith & Family):
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Business Phone:*
Phone:
Gender:* Female   Male  

**Find your employee ID Number one of three ways: (1)Call the HR Customer Service Center at 877-4589699 (2)Look on your pay stub just to the right of your name (3)Look in Kronos.