Hamptons Health Society

Yes, I want to support the Hamptons Health Society in its ongoing effort to improve local healthcare.

Enclosed is my contribution for $ __________.

Name _________________________________________________

Address _______________________________________________

City, State, Zip _________________________________________

Please send contributions to:

Hamptons Health Society 
c/o Peter Michalos MD 
365 County Rd 39A, Unit 14 
Southampton, NY 11968-5243