Coporate Challenge Payroll Deduction

Register for Corporate Challenge and then complete payroll deduction authorization

Register to walk or run the Corporate Challenge, held on Tuesday, June 7 at 6:25pm at Onondaga Lake Park. Visit the programs page at crouse.org/corporatechallenge to register for the event and complete the below payroll deduction authorization.

If you attend the event and complete the course, you will receive a $25 Visa gift card.

Question Title

* 1. Please enter your information.

First Name

Last Name

Crouse Employee #

Email address

Phone number

Question Title

* 2. Have you registered on the JP Morgan Chase website for the event?

Yes, I have completed this requirement

No, and I understand I need to complete this step to participate in the walk/run

Indicate Crouse Team shirt preferences in the following questions. Shirts are moisture-wicking material. Men's shirt is a unisex fitting shirt with a crew neck, women's style is a women's cut with a v-neck. Sleeveless and short-sleeve options available. Design to be determined.

Question Title

* 3. Please indicate shirt selection below:

	Select Size and Style	Short-sleeve or Sleeveless Option
.	. Select Size and Style menu	. Short-sleeve or Sleeveless Option menu

Question Title

* 4. Payroll deduction amount is $36 and includes a Corporate Challenge shirt, Crouse team shirt and post-race refreshments at the Crouse tent. Complete the race course and receive $25 reimbursement, which makes your final cost only $11! Indicate payroll deduction preference:

$36 deducted from a single paycheck

$36 divided equally and taken from two paychecks

Question Title

* 5. I authorize my employer's payroll department to deduct the $36 Payroll Deduction from my paycheck. This will be deducted from one or two paychecks, according to my direction provided in the previous question. I agree that in the event of separation from employment I am legally obligated to satisfy the balance immediately through payroll deduction or direct payment to my employer.

Initials

Date

Type Name
(considered your
electronic signature)

Thank you for participating, you will receive email updates about the race from the Crouse team.

And congratulations again to Katie Mutter, a member of the Crouse family who took
FIRST PLACE
for the women last year!