(To print form, go to your "file" menu and select "print")


Name: ________________________________


Address: ________________________________


City: ________________________________


State: ______   Zip: ______


Enclosed is my donation in the amount of: $____________


*PLEASE - Make all checks payable to Hospital Audiences Inc.

*PLEASE - Write MUSIC THAT HEALS in the memo portion of your check

MAIL TO:
Music That Heals
Attention: Patrick McGuire
c/o HAI Inc.
548 Broadway, 3rd Floor
New York, NY 10012-3950

Thank you for your generosity



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In Collaboration with Hospital Audiences Inc.