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Designate my gift to:

Department of Neurology Gift Fund - The Department of Neurology at the University of Utah is committed to ending neurological disease through specialized patient care, innovative research, and the education of tomorrow's physicians. We are grateful to those in our community whose contributions support these efforts. Your gift makes a very real impact in the fight against neurological disease and may be designated to furthering the effort of your choosing. For questions or more information, please contact melisa.moon@hsc.utah.edu

Gift Details Gift Type:

Amount: $

Payroll Deduction (set amount)

Deduct: $ from my paycheck until my contribution of
Amount: $ is reached.
Beginning Date:
(month/year)

Payroll Deduction (Ongoing)

Amount: $ to deduct from my paycheck until I request a change or termination in writing.
Beginning Date:

In Honor/Memory

This gift is: in memory of
in honor of

not applicable

Honoree's name:

Notify Someone Of This Gift

Would you like someone to be notified of this gift?

Name:
Address 1:
Address 2:
City:
State/Province:
Zip/Postal Code:
Country:

Special Instructions

Would you like to add special instructions?

Special Instructions:

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Please note that by giving via payroll deduction you are not entitled to any goods or services that you might otherwise receive if giving through a different method.

Matching gifts

Check here to see if your employer will match your gift!

Other options

Scheduled Pledge Payments

A pledge is an agreement to pay over a period of time with scheduled payments or transfers from a bank account or credit card. Please mail a completed PDF with your credit card number or a voided check.

Pledge Agreement Form (pdf)

By Phone

To make a pledge by phone or give in other ways (planned gifts, securities) call 1-800-716-0377. If you call after hours and leave a message, we will return your call the next business day.

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