Generosity Champions Membership Form


Name*
Date of Birth*
Address*
Benefit Choice*
Benefit Choice*
Benefit Choice*
Benefit Choice*
Benefit Choice*
Benefit Choice*
Benefit Choice*
Benefit Choice*
Donation Level*
I authorize ongoing payroll deduction of the amount indicated as my gift to the employee giving program at AdventHealth. I understand that I can modify, upgrade,downgrade or cancel my membership in the program at any time. If the project I've indicated reaches the point of being completely funded, my gifts will continue to benefit that area for its strategic priorities. Gifts to the employee giving program at AdventHealth are tax deductible within the IRS regulations.*
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You will be emailed a copy of this information for your records.