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| 5416 East Lake Road |
| Erie, PA 16511 |
| (814) 899-8600 |
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Your Donation
helps the Brevillier Village Auxiliary fund resident-centered projects and
programs. See previous page for Listed Programs. |
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AMOUNT OF DONATION: |
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* Check the appropriate boxes below* * Print neatly when you fill out the form* * Use a black or blue ink only* |
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Make Checks Payable to: Brevillier Village Auxiliary |
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| $5.00 |
$50.00 |
| $10.00 |
$100.00 |
| $20.00 |
Other Amount $__________________________________ |
| NAME:__________________________________________________________________ |
| ADDRESS:_______________________________________________________________ |
| CITY:________________________ STATE:__________________________ |
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ZIP:_______________ PHONE:_____________________________ |
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*This is a printable form* |
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I want to become an active Brevillier Village Volunteer. Please contact me. |
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Thank you for supporting the BVA and every donation is greatly appreciated. |
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| If there are more questions regarding the BVA or the BVA Pledge Form. |
| Please contact Volunteer Coordinator |
| at VMottern@brevillier.org |
| or write to: |
| Vickie Mottern- Volunteer Coordinator |
| 5416 East Lake Road |
| Erie, PA 16511 |
| Phone: (814) 899-8600 Ext: 244 |
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| Monday-Friday |
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Brevillier Village |
| 5416 East Lake Road |
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Erie, PA 16511 |
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Phone: 814-899-8600
Fax: 814-898-1910 |
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Department of Housing & Urban Development
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Handicapped Accessible |
 American Association of Homes and Services of Aging. |
.jpg){kind=small} Pennsylvania Association for Non-Profit Homes of Aging. |
