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A Trenton Memorial Hospital Foundation Fundraiser

A 50/50 lottery for full and part-time QH hospital employees! For just $5 per pay period, you could win half the funds raised every payday. The rest supports QH Trenton Memorial Hospital’s urgent needs, funding vital equipment and improved patient care.

Fillout the Form Below

Employee Information

Name Date Extension

Print Name *

First

Last

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Phone

Work Phone and Extension

I authorize the payroll deductions for the entries stated above to be deducted through QHC Payroll until I choose to withdraw, at which time I will provide two weeks written notice to TMH Foundation. I verify that I have read the Rules of Play and that my employee and contact information is correct and current. I consent to the publication of my name in the event that my entry is drawn.

Signature *

Date

Note: Please keep us updated if you change departments or contact information