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Payroll Deduction Authorization Form

Please note:

  1. All tickets, tables, etc. must be paid in full via payroll deduction by/including August 1, 2011.
  2. Cancellations will be accepted until July 15, 2011. 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

  • At the time of purchase, whether group or individual, seating assignments for dinner and the Kiva theatre are reserved electronically.
  • Adding individuals to an existing group or ticket for seating proximity is not possible.
  • Make sure your group is complete at the time you order and pay for the tickets.
  • Please read the Guide to Group Ticket Purchasing.

Payroll Deduction Authorization Form

I authorize a payroll deduction for "Laughter is the Best Medicine." The amount of $160.00 per ticket will be deducted from my Presbyterian Healthcare Services/Presbyterian Health Plan payroll over the remaining pay periods of 2011.

Sign up beforePay periods Amount deducted
per ticket purchased,
per pay period
March 311$14.55
March 1710$16.00
March 319$17.78
April 148$20.00
April 287$22.86
May 126$26.67
May 265$32.00
June 94$40.00
June 233$53.34
July 72$80.00
July 211$160.00

  
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 $160 per ticket. (The amount that is tax deductible is $77.)

I want to purchase table(s) at $1,600 per table. (Each table seats 10 people. The amount that is tax deductible is $810 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, to:

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

Checks should be payable to Presbyterian Healthcare Foundation.

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