Join us and go casual for kids on Friday, September 15!

Order your t-shirt today for only $10. All proceeds benefit HSHS St. John's Children's Hospital. Please note, St. John's colleagues may not wear blue denim with their t-shirts on September 15.

Questions? Call or email Katie Impson at ext. 45161.

Name:
Colleague ID #:
Department/Unit:
Daytime phone number:
Home address:
City, State, Zip:
I consent to have $10 deducted from my paycheck:	You must be paid by SJS (not HSHS or HSHS Medical Group) to use this option.
I would like to pay the $10 with my debit or credit card:	Link to electronic payments is below.
I would like to pay the $10 in cash:	Please print out this form and send it along with your $10 to the Foundation office by August 9.
My t-shirt size:	S M L XL 2X 3X
I work on the hospital campus:
If you work on the hospital campus, what is your specific location:
I work offsite at this location:

Pay via credit card here.