A Little Change Makes a Big Difference Online Pledge Form | Flint Foundation Documents and Links

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I authorize the following amount to be deducted from my pay for "A Little Change Makes a Big Difference." I agree that the deductions will continue until I give my employer's payroll department written notice that I wish to discontinue the deductions. I understand that I may discontinue the deductions at any time.

Amount per Pay (Minimum is $1.00 per pay)*

Number of Pays*

Total Amount*

Your contribution is tax deductible to the extent allowed by law, as McLaren is a non-profit health care organization.
The payroll deduction is an after-tax deduction.

YES! I would like to support the A Little Change Makes a Big Difference campaign in this way: *

Note: Payroll Deduction to begin on next available pay period unless you specify otherwise.

MMG and Corporate employees are not eligible for payroll deduction.

Signature (Typing your name here indicates that all of the above information is accurate and acts as your electronic signature.) *

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