Employees That Care Application

Note: Fields marked with an * indicates required field




Donation Information







* If your pledge to the ETC Club totals at least $100 per year, you will also become a member of the Cornerstone Club of McLaren Port Huron Foundation. Cornerstone Club recognition (you can include spouse's name below)

If you wish to make a lump sum gift instead of a payroll deduction, you may use your credit card below. If using check or cash, please print this form once complete and attach your check or cash and either take it to the Foundation Office, or call the Foundation Office and a staff member will pick it up.

$

By submitting this form, I certify that I am an(a): Employee at McLaren Port Huron and either (1) desire to have the amount indicated deducted from my paycheck per pay period or (2) to have the amount indicated charged to my credit card.