• W.H.A.T. Club Registration

    W.H.A.T. Club represents the Tri-State Memorial Hospital employees who donate annually to the Tri-State Hospital Foundation. Those employees set an example for the community by pledging their own support and encouraging the community to do the same.
  • I give Tri-State Memorial Hospital & Medical Campus authorization to deduct the following amount on an annual basis: (please check the box below that coincides with your donation, then specify the amount to be given)

  • If donating per pay period, below is how much your donation equivilatent to for 1 year (or 26 pay periods)

    • $2 = $52
    • $4 = $104
    • $5 = $130
    • $10 = $260
    • $15 = $390
    • $20 = $520
    • $25 = $650
    • $30 = $780
    • $35 = $910
    • $40 = $1,040
    • $42 = $1,092
    • $45 = $1,170
    • $50 = $1,300
  •  -
  • By clicking submit you are authorizing Tri-State Memorial Hospital & Medical campus to deduct your chose of either a specified amount dollars per pay period, a one-time donation the first pay period in January, or a specified amount of paid time off hours. The information that you are authorizing is outlined in this form above. 

  • Should be Empty: