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One out of every five people has some form of a disability. The Blue Ridge Independent Living Center, Inc. assists people with disabilities to lead independent lives. The Center also promotes community change and awareness. Help us to assist more individuals!

NAME: (please print)

ADDRESS

CITY STATE ZIP

___ $10 ___ $25 ___ $50 ___ $100 ___ $250 ___ $500 Other $ ______

Your gift may be made in memory of a deceased loved one or in honor of a special occasion. Such gifts will be acknowledged to the person you designate without mentioning the amount given.

In Memory of or In Honor of (Circle one)

NAME

ADDRESS

CITY STATE ZIP

Please make check payable to the Blue Ridge Independent Living Center, Inc. Our address is 1502B Williamson Rd. NE Roanoke, VA 24012 - All gifts are tax deductible.