Saint Francis Foundation

MIRACLES Giving Form

We hope that you will join us for MIRACLES XXXI

Saturday, September 11, 2020
6PM - Midnight
The Connecticut Convention Center, Hartford, CT

Beneficiary: The Promise Campaign benefiting Johnson Memorial Hospital

Lifetime Achievement Award Recipients:
Dr. Bimalin Lahiri and Dr. Brendan Fox

To purchase tickets with a credit card, please click here. To purchase tickets via payroll deduction, complete the form below.

 


Step 1: Colleague Information (* denotes required fields)

First Name: *
Last Name: *
ColleagueID: *
Phone Number: *
Email: *
Dept. Name: *

Step 2: Contribution *

Ticket Price $500
Number of tickets   
1. Payroll Deduction
I wish to contribute via PAYROLL DEDUCTION.
I authorize my PAYROLL DEDUCTION of $ per Pay Check (every two weeks) until 9/6/19.
I authorize a onetime PAYROLL DEDUCTION of $.
2. Cash or Check
In the amount of $ will be mailed directly to the Foundation Office, 95 Woodland Street, 2nd Floor Hartford, CT 06105. Please make checks payable to Saint Francis Foundation.
3. Credit Card Donation
In the amount of $
 
Total Due: $0
Please ensure your payment amounts above match the Total Due.