The following form may be printed completed and sent to: Visiting Nurse Association of Indiana County, 850 Hospital Road, Suite 3000, Indiana, PA 15701

My gift is in memory/honor of: 

____________________________________________________________

Your Information (please print)

Name:                _____________________________________________

Address:          _____________________________________________

City, State, Zip:            _____________________________________________

Daytime phone:   ______________            Evening phone:            ______________

E-mail:               _____________________________________________

Please notify ( no amount will be mentioned)

Name ___________________________________________________

Address__________________________________________________

City, State, Zip______________________________________________

All donations are tax deductible. Thank you your for your kind generosity and support

Tree of Lights  A VNA Tradition returns to the IRMC campus

Hope Takes Flight

Monarch Butterfly Release in honor and memory of your loved ones. August 19, 2012 at 2PM

YMCA of INDIANA COUNTY

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