AltaMed

AltaMed Foundation Logo

Pledge Type

Tell us how much and how many installments

A. Ongoing Pledge - recurring donation per pay period, do not have to renew each year

B. One-time Pledge - one-time donation deduction from 1 pay period

Donation Type

Donation Amount

Make this gift anonymous

Employee information

First Name

Last Name

Mobile Number

Employee ID#

Work Site

Department

Solicitor (Giving Ambassador)

Address (Tax acknowledgement letter will be sent to this address)

City

State

Zip

Acknowledgement

I authorize AltaMed Health Services Corporation to make deductions for the amount and occurrence specified above to the employee giving program.

Please enter your full name below to confirm your participation in the program.

Total Donation Amount

If you selected option A, recurring payments, the total amount is the dollar amount per pay period that will be deducted and does not reflect the total donation you will make.

Your payroll deductions are being directly contributed to the AltaMed Foundation, a 501c3 nonprofit organization, whose 501c3 Tax ID is: 95-4090420. You can modify or cancel your participation at any time.