Demonstrate your commitment to quality and accessible healthcare for the Lower and Outer Cape by pledging your support. Please share the costs of caring by filling out this easy form. To print the form on your computer, click File in the upper left corner of the browser window, then select Print... and follow the menus from there. Then either mail or fax to OCHS.
Mail to:
Office of Development
Outer Cape Health Services
P.O. Box 1944
North Eastham, MA 02651
Or Fax to:
Development, OCHS
508-240-0499
| Name(s): _____________________________________________ |
| Address: _____________________________________________ |
| City:__________________________ |
State: ______ |
Zip:_______ |
| Telephone (_____) ___________________ |
| Yes! I support Outer Cape Health Services. Enclosed is my
gift of: |
| [ ]$1000 |
[ ]$500 |
[ ]$250 |
[ ]$100 |
[ ]$50 |
[ ] other ________ |
| [ ] My check for $ __________ is enclosed |
| [ ] Please charge my VISA or Mastercard: |
| Account # ______________________________ |
Expires:______/______ |
| Signature ______________________________ |
Date:_______________ |
Outer Cape Health Services is a non-profit community health center serving
the Outer Cape. Contributions are tax-deductible under the provisions of IRS
501(c)3.
