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Thank you for supporting the Associate Giving Campaign,
It's All About The Kids!

No matter what job you do, no matter your location or department, you help Nemours restore, improve and promote the health of children in ways both large and small. In fact, you are Nemours, and you are completely invested in our mission. Your participation gives you another opportunity to help children, this time with a charitable gift.

* required information
Select Gift Frequency
I would like to make a one-time gift for the following amount:
:* $
I would like to make a recurring gift.
Gift Amount* # of Payments Payment Frequency Total Gift Amount
$ X = $
NOTE: Each payment, including the first payment, will be made on day 15 of the month based on the payment frequency you have indicated.
Donor Designations
Select a designation for your contribution.

If you choose "other" for the designation below,
please specify your designation in the "Designation Note"
field in the bottom section of this form.

Donor Information

**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.

Employee ID Number**:
If you are a Nemours Associate, please specify the geographic location where you work:*
Prefix (Mr., Mrs., Ms. Dr.):
First Name:*
Last Name:*
Middle Initial:
Address Line 1:*
Address Line 2:
ZIP/Postal Code:*
Business Phone:
Mail to this Address?
Payment Information
:*   Explain
Credit Card Type:*
Credit Card Expiration:*
Billing Information
If the billing information is the same as the contact information check this box.
If not please fill out the information below:
Designation Note / Honoree Info

Specify the designation of your gift
(if you chose "other" in the section above.)

You can also make your gift in honor of your coworker by filling in the honoree information below. A letter will be sent on your behalf to the honoree, including any message you include below.

Orlando Associates, please specify your department:
Designation Note:
Honoree First Name:
Honoree Last Name:
Tribute Type:
By clicking Submit,
your credit card will be processed