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I want to help underwrite the cost of a hearing aid for the Help America Hear program.

$2500.00 - Hearing Aid

$1000.00 - Additional extended warranty on two hearing aids (most patients require two hearing aids)

$500.00 - Additional extended warranty on one hearing aid

$300.00 - 2 custom behind the ear molds

$250.00 - batteries for one year

$150.00 - custom behind-the-ear hearing aid mold

$25.00 - batteries for one month

I would like to make a tax-deductible contribution in the amount of $

If you would like to pay by check, please do so at :

Foundation For Sight & Sound
P.O. Box 1245
Smithtown NY 11787

For more information
please contact The Foundation for Sight and Sound

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