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Your Help Matters- HES Donation Form

Thank you for supporting Health Equity Solutions! Your donation helps HES further its mission to increase health equity and improve the quality of life for all CT residents regardless of race, gender, sex or socioeconomic status.

Amount

$100

$50

$25

Donation Schedule

Contact Information

Name

First Name

Last Name

Verify Email

Phone

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Add 3% to my total amount to help cover the payment processing fees