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2013 Laughter is the Best Medicine

 2013 Laughter Header Art

August 24, 2013

Payroll Deduction Authorization Form

Please note:

  1. All tickets, tables, etc. must be paid in full via payroll deduction by/including August 1, 2013.
  2. Cancellations will be accepted until July 19, 2013. After that date, in the case of a sold out venue, we may assist you in selling your tickets to another interested buyer.

About Buying Group Tickets

  • Please contact the Foundation at 505-724-6586 if you would like to request seating for a group purchasing tickets separately.
  • Make sure your group is complete at the time you order and pay for the tickets.

Payroll Deduction Authorization Form

I authorize a payroll deduction for "Laughter is the Best Medicine." The amount of $180.00 per ticket will be deducted from my Presbyterian Healthcare Services/Presbyterian Health Plan payroll over the remaining pay periods of 2013.

Sign up beforePay periods Amount deducted
per ticket purchased,
per pay period
February 1412$15.00
February 2811$16.37
March 1410$18.00
March 289$20.00
April 118$22.50
April 257$25.72
May 96$30.00
May 235$36.00
June 64$45.00
June 203$60.00
July 42$90.00
July 181$180.00

  
If I terminate my employment before the deduction is paid in full, I authorize Presbyterian Healthcare Services to deduct the remaining balance from my final check.

I want to purchase ticket(s) at $180 per ticket. (The amount that is tax deductible is $97.)

I want to purchase table(s) at $1,800 per table. (Each table seats 10 people. The amount that is tax deductible is $1,010 per table.)
  

Name:
Street Address:
City, State, Zip:
Home phone:
Work department or location:
Work phone:
E-mail:

 

Thank you for your ticket request!

If you prefer to pay by check, please complete, print, and send this form, with your check, payable to Presbyterian Healthcare Foundation, to:

Presbyterian Healthcare Foundation 
P.O. Box 26666 
Albuquerque, NM 87125-6666

You can return your form with credit card payment by fax to (505) 841-1113 or email mhitchcoc@phs.org.

For additional information, please call (505) 724-6586.