First Name
  
     Last Name
  
     Address
  
     E-mail
  
     Phone Number
  
     City
  
     State
  
     Zip
  

  I am homebound and would like to    purchase home delivered meals.

  I would like to make a donation:
  in honor of
  
  in memory of
  
  to sponsor a specific client   

  I would like to sponsor a needy client.
      $18.75 weekly
      $75.00 monthly
      $900.00 yearly
      $
  
I would like to be a volunteer driver for Meals on Wheels.

I would like make a monetary donation to the Council on Aging.     
        $25 
        $50 
        $100 
        Other  $

I would like to be a telephone reassurance volunteer.

I would like to volunteer at the:
        Butts County Senior Center
        Lamar County Senior Center
        Pike County Senior Center
        Spalding County Senior Center
        Upson County Senior Center

I would like to volunteer for:
  

Comments


      Please make your tax deductible check      payable to:
     Council On Aging
     P.O. Box 169
     Griffin, GA 30224