title
   

PROFILES IN POSITIVE AGING

                           

The profile will be posted on The Center for Positive Aging website for one year.
A copy of the profile will be sent to either the donor
(to be framed and presented as a gift) or to the honoree.

Requirements for Profiles in Positive Aging:

1. One photo per profile. A digital photograph can be submitted or you may
           send a photograph which we will scan and return.
2. A donation of at least $100.00 is requested.
3. Copy should be limited to 200 words or less

Name of the Person you are nominating to be profiled

Your Name

Address

Phone Number

E-Mail Address

Would you like the nominee to receive a certificate?
Yes         No

If yes, we will need their address:

Please enter the profile here (200 words or less):