Senior Care of Brevard - Donation Form

THE NEED

Brevard County is fast approaching a point where the needs of those requiring some kind of care (young as well as old) are quickly overwhelming the resources set up to help them. Costs are escalating. Funding is depleted. Many have no one to assist them. The next decade will see Brevard's older citizens increase to over 120,000; those over 85 will increase by 264%. We will all be affected...children, youth, and adults.

Rampart Group, dba Senior Care of Brevard is a tax exempt, non-profit organization founded right here in Brevard. Your financial support is vitally needed to fund this operation!

Be part of the solution! Donate and help us make a difference!

Please fill in the form below then click on the "Print Form" button.

You may also donate using PayPal.

I am making a gift of:

Amount: $

This gift is in memory of:

Name:

Date of Birth:   format: (mm/dd/yyyy)

Date of Death:   format: (mm/dd/yyyy)

Please add this person to your "Remembrance" page.

Fill in your name and address to ensure correct preparation
of your receipt for tax purposes.

Name:

Address:

City:

State:

ZIP:

Email Address:

I may be contacted by e-mail.

Telephone Number:

Please make checks payable to Rampart Group/Senior Care of Brevard