Please consider supporting the Geriatric Wellness Center with a tax deductible contribution. With your continued support, the Wellness Center is able to achieve its mission of assisting older adults to attain their highest levels of physical, mental, and spiritual well-being.
Please print this form and return to:
Yes, I'm interested in opportunities to help.
_______ I would like to volunteer.
_______ I would like to contribute.
Name ____________________________________________________________________
Address __________________________________________________________________
City _____________________________________ State _______ Zip ________________
_____ Donation of durable medical equipment.
______ $25 - provides foot or ear care visit with Geriatric Nurse Practitioner.
______ $50 - provides 60-minute consultation with Clinical Counselor.
______ $100 - provides 25 screenings such as blood sugar, blood pressure.
______ Other - Every gift large or small is greatly appreciated and provides support to the seniors and their caregivers we serve.
$__________ Please make checks payable to Wellness Center
I wish my gift to be a Memorial/Honorarium.
(Please notify family/honoree of
Memorial/Honorarium gift):
Name _______________________________________________________________________
Address _____________________________________________________________________
City____________________________________________ State _______ Zip _____________