check your mail for abin-pa’s winter appeal · include personal assistance and rehabilitation....

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©2013 Acquired Brain Injury Network of Pennsylvania, Inc. PERMISSION GRANTED TO PHOTOCOPY AND DISTRIBUTE UNCHANGED AND AT NO CHARGE TO ALL WHO ARE INTERESTED. ACQUIRED BRAIN INJURY NETWORK NEWS December 1, 2013—2013/#12—83rd Issue 215.699.2139, 800.516.8052, Fx: 215.699.5139 2275 Glenview Drive, Lansdale PA 19446.6082 [email protected] www.abin-pa.org Our slogan will appear here—any suggestions? COMMCARE & OBRA These Waivers are open! Benefits are life-long and include personal assistance and rehabilitation. Get on the list! Call to apply! 877-550-4227 Greetings! Thank you to Joan Steinberg of Pampered Chef, Renee Austin of Bluesette Boutique and participants in these two online benefits for ABIN-PA! And Tx to Michelle Gallagher who will do a Thirty-One benefit in February! As you know, ABIN-PA has been raising expectations for those with brain injury since 2007 by connecting them to local, state, and federal resources for support and recovery. Steady gifts from ABIN-PA’s subscribers are making this connection possible as well as efforts to improve resources and access. Your gift is essential today to continue this tradition of service by assuring a strong financial foundation for 2014. InfoLine data entered so far shows ABIN-PA has handled over 1,874 calls and there is a constant stream of new callers. Please take the bold step of extending our request to your family and friends. If each subscriber can give or collect a donation of $30 or more, we should reach our goal of $30,000 by January 15th, 2014. With 1,220 subscribers, this should not be a problem. Please send your gift by December 31st for a 2013 tax deduction and consider becoming a monthly donor at $10 or more, adding to our existing $200 in monthly pledges. In the Winter Appeal, look for a picture of the new ABIN-PA Partner’s card for donors, a library flyer on children’s rehabilitation, and a request for ABIN-PA InfoLine volunteers. Please support ABIN-PA today! Barb Dively CHECK YOUR MAIL FOR ABIN-PA’s WINTER APPEAL Your gift or monthly pledge will entitle you to a personal 2014 ABIN-PA Partner Card TARGET $30,000 by January 15th, 2014 Your gift connects survivors and families to county, state and federal resources for recovery. INDEX—IN THIS ISSUE PAGE 1. Editor; CommCare Open; Appeal; Index 2. Events; November Board Meeting 3. Supportive Housing; Donor Thank You 4. CEC’s; Severe ABI/TBI; Mission; Resources 5. Wendy Myers Thanks Bob Neal; Pete Moughan, Extraordinary Minister 6. Your Child; Legislation Alert; Ad Rates 7. InfoLine Volunteering; Dan’s Father 8. Your Message to ABIN-PA; Your Donation PLEASE LIKE US ON OUR TWO FACEBOOK SITES!

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Page 1: CHECK YOUR MAIL FOR ABIN-PA’s WINTER APPEAL · include personal assistance and rehabilitation. Get on the list! Call to apply! 877-550-4227 Thank you to Joan Steinberg of Pampered

©2013 Acquired Brain Injury Network of Pennsylvania, Inc. PERMISSION GRANTED TO PHOTOCOPY AND DISTRIBUTE UNCHANGED AND AT NO CHARGE TO ALL WHO ARE INTERESTED.

ACQUIRED BRAIN INJURY NETWORK NEWS December 1, 2013—2013/#12—83rd Issue

215.699.2139, 800.516.8052, Fx: 215.699.5139 2275 Glenview Drive, Lansdale PA 19446.6082

[email protected] www.abin-pa.org Our slogan will appear here—any suggestions?

COMMCARE & OBRA These Waivers are open! Benefits are life-long and include personal assistance and

rehabilitation. Get on the list! Call to apply! 877-550-4227

Greetings! Thank you to Joan Steinberg of Pampered Chef, Renee Austin of Bluesette Boutique and participants in these two online benefits for ABIN-PA! And Tx to Michelle Gallagher who will do a Thirty-One benefit in February!

As you know, ABIN-PA has been raising expectations for those with brain injury since 2007 by connecting them to local, state, and federal resources for support and recovery. Steady gifts from ABIN-PA’s subscribers are making this connection possible as well as efforts to improve resources and access.

Your gift is essential today to continue this tradition of service by assuring a strong financial foundation for 2014. InfoLine data entered so far shows ABIN-PA has handled over 1,874 calls and there is a constant stream of new callers.

Please take the bold step of extending our request to your family and friends. If each subscriber can give or collect a donation of $30 or more, we should reach our goal of $30,000 by January 15th, 2014. With 1,220 subscribers, this should not be a problem. Please send your gift by December 31st for a 2013 tax deduction and consider becoming a monthly donor at $10 or more, adding to our existing $200 in monthly pledges.

In the Winter Appeal, look for a picture of the new ABIN-PA Partner’s card for donors, a library flyer on children’s rehabilitation, and a request for ABIN-PA InfoLine volunteers.

Please support ABIN-PA today!

Barb Dively

CHECK YOUR MAIL FOR ABIN-PA’s WINTER APPEAL

Your gift or monthly pledge will entitle you to a personal

2014 ABIN-PA Partner Card

TARGET $30,000 by January 15th, 2014

Your gift connects survivors and families to county, state and

federal resources for recovery.

INDEX—IN THIS ISSUE PAGE

1. Editor; CommCare Open; Appeal; Index 2. Events; November Board Meeting 3. Supportive Housing; Donor Thank You 4. CEC’s; Severe ABI/TBI; Mission; Resources 5. Wendy Myers Thanks Bob Neal; Pete

Moughan, Extraordinary Minister 6. Your Child; Legislation Alert; Ad Rates 7. InfoLine Volunteering; Dan’s Father 8. Your Message to ABIN-PA; Your Donation

PLEASE

LIKE US ON OUR TWO

FACEBOOK SITES!

Page 2: CHECK YOUR MAIL FOR ABIN-PA’s WINTER APPEAL · include personal assistance and rehabilitation. Get on the list! Call to apply! 877-550-4227 Thank you to Joan Steinberg of Pampered

©2013 Acquired Brain Injury Network of Pennsylvania, Inc. PERMISSION GRANTED TO PHOTOCOPY AND DISTRIBUTE UNCHANGED AND AT NO CHARGE TO ALL WHO ARE INTERESTED.

ABIN-PA NETWORK NEWS—December 1, 2013—Page 2

DATES & OPPORTUNITIES

Board Meetings. 2-4pm Sunday Lansdale Call-in: 218.862.1300 PassCode:127105 Jan.19, Feb.16, Mar.16, Apr.13, May18, Jun. 22, Jul.20, Aug.17, Sep.21, Oct.19,

Nov.16, Dec14. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

APRIL 5TH—PITTSBURGH LUNCHEON MAY 3RD—PHILADELPHIA LUNCHEON

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COURSES BY PHONE—FAMILIES & SURVIVORS

#1—General Information—Open to All The basics about brain injury & recovery. #2—Resources & Role Plays—Open to All #1 & #2 required for InfoLine volunteers.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PEER CONNECT PHONE & EMAIL PARTNERS

Do you want to chat with another survivor or family member? Try a PeerConnect match!

Main Line Rehabilitation Associates, Inc.

Home & Community Based Cognitive Rehabilitation Therapy

Serving Eastern Pennsylvania and the Greater Pittsburgh Area

www.mainline-rehab.com 877- 480-6714

ABIN-PA NOVEMBER BOARD MEETING

PRESENT: Barry/Anna Marie Childress, Barb Dively, Megan Herlihy, Erikka Johnston, Tom Kisling, George Matwiejczyk, Dan Rohrback, Madelaine Sayko, Joan Steinberg. 1. October closing balance $9,241.43. 2. Unemployment Comp.—resolved. 3. Comments to Rep. Caltagirone on

Mental Health Procedures Act. 4. Publicizing Cog Rehab for <21 by OTs. 5. Bylaws amended for clarification. 6. Officer & Director slate prepared. 7. Appointed—Fund Development: Joan,

Chair; Megan, Tom, Eugenia Laux. 8. Elected to the Board—Tom Kisling. 9. Appointed to Advisory Panel—Jean Hurd. 10. CECs fo 2014: D. Baublitz, C. Glisson, E.

Laux, F. Lowry, T. McCloskey, R. Neal, D. Pasekoff, D. Rohrback, Jr., M. Sayko, J. Steinberg, P. Strenk, L. Strouse, P. Vietro, K. Wolf, W. Wood, M. Zawalsh.

11. Slogan—survey in January newsletter. 12. Fundraising –Pampered Chef, Bluesette

Boutique—in newsletter, web, FaceBook. 13. Statistics—over 1,874 calls handled. 14. Will hold alternatives conference since

VA now endorsing for TBI and PTSD.

SELECTED PAST EVENTS: 2013.11.12—MCFTF—*D. Nagele,PsyD 2013.11.14—CogRehab, King of Prussia—Free 2013.11.19—Northampton Cty BH —*B. Dively

SELECTED FUTURE EVENTS: 2013.11.21—Gov Adv Com. PWD—B. Dively 2013.02.14—Grand View Hospice—P. Strenk

MONTHLY EVENTS: 1. Brain Injury Coalition—Dorene Pasekoff,

Peggy Vietro 2. Montgomery County Children’s

Roundtable, MC Truancy Workgroup, MC Forensic Task Force, Greater North Penn Collaborative—Barb Dively

3. Phoenixville Area Resource Network—Dorene Pasekoff *Presentation

Cognitive Rehabilitation Therapy

Rooted in Hope Results Achievement .

Page 3: CHECK YOUR MAIL FOR ABIN-PA’s WINTER APPEAL · include personal assistance and rehabilitation. Get on the list! Call to apply! 877-550-4227 Thank you to Joan Steinberg of Pampered

©2013 Acquired Brain Injury Network of Pennsylvania, Inc. PERMISSION GRANTED TO PHOTOCOPY AND DISTRIBUTE UNCHANGED AND AT NO CHARGE TO ALL WHO ARE INTERESTED.

ABIN-PA NETWORK NEWS—December 1, 2013—Page 3

SUPPORTIVE HOUSING "PA DPW Personal Care Home Information"

If you are 18 or older and need housing with services, contact your county department of aging for a list of Personal Care Homes (PCH) and an assessment to see if a PCH is a good choice for you. From the state website:

“Personal Care Homes (PCHs) are residences that provide shelter, meals, supervision and assistance with personal care tasks, typically for older people, or people with physical, behavioral health, or cognitive disabilities who are unable to care for themselves but do not need nursing home or medical care. While available services vary and are based on the individual needs of each resident, services provided at a typical PCH include assistance with: Arranging for/ managing health care; Arranging for transportation; Assisting with/ administering medications; Bathing; Caring for possessions; Doing laundry; Eating/drinking; Getting/ caring for seasonal clothes; Making/ keeping doctor's appointments; Participating in social/recreational

activities; Personal hygiene; Positioning in bed or chair; Shopping/managing finances; Toileting/bowel and bladder management; Using prosthetics; Using the telephone/writing letters; Walking/getting in and out of bed or chair.

Personal Care Homes are inspected and licensed by the Pennsylvania Department of Public Welfare. They are usually privately-owned, although some are operated by local governments or non-profit agencies. In Pennsylvania, homes may be licensed to care for as few as four people and as many as several hundred. To find information on a Personal Care Home near you see the Personal Care Home Directory .“ [See state website.]

THANK YOU TO OUR DONORS!

OCTOBER DONATIONS

Cari Brehm, Brittany Constant-Galiardi,

John Dively, Robert Drucker, Andrew Follmer, Megan Herlihy, Sherri Herschfeld,

James Polk, Lynette Savoy, Carla Schaeffer, Steven Silberstein.

Organizations: Success Rehab

NOVEMBER DONATIONS

Phyllis Casper, Robert Drucker, Marianne Murray, Patricia Spess, Charlene Towers.

In Honor of: Daniel Rohrback, Sr., from

Robert Drucker

Page 4: CHECK YOUR MAIL FOR ABIN-PA’s WINTER APPEAL · include personal assistance and rehabilitation. Get on the list! Call to apply! 877-550-4227 Thank you to Joan Steinberg of Pampered

©2013 Acquired Brain Injury Network of Pennsylvania, Inc. PERMISSION GRANTED TO PHOTOCOPY AND DISTRIBUTE UNCHANGED AND AT NO CHARGE TO ALL WHO ARE INTERESTED.

ABIN-PA’s MISSION ABIN-PA is dedicated to increasing public

awareness about acquired brain injury and to providing support, education, information, advocacy and other services for individuals with acquired brain injury and their families.

ABIN-PA NETWORK NEWS—December 1, 2013—Page 4

COUNTY COORDINATORS Call if you have questions!

Chester—Dorene Pasekoff—610-506-3372 Cumberland—Kim Wolf—717-249-4006 Lancaster—Wendy Wood—717-393-5990 Philadelphia—Dan Rohrback, Jr.—215-291-4235

The Road to Recovery

A Weekly Therapeutic Group Thursdays 9 - 10:30 am

A program for adults with brain injury. Activities include socialization, planning, organization,

cognitive rehabilitation, and community outings.

www.thecenterinwarrington.com 215-491-1119

RESOURCES PDO = “PA Department of”

____________________________________________

Aging & Disability Resource Centers—State ______________________________1.866.286.3636 Brain Injury InfoLine—ABIN-PA ____________www.abin-pa.org, 1.800.516.8052 Brain Injury Resource Line—BIAPA ______________ www.biapa.org,1.800.444.6443 Brain STEPS—school re-entry—BIAPA ______________________________1.724.944.6542 Client Assistance Program for OVR & CIL’s ______________________________1.888.745.2357 Consumer Protection—PA Atty. General ______________________________1.800.441.2555 Crime Victims—www.pbpp.state.pa.us ___________1.800.563.6399 and 1.800.233.2339 Defense & Veterans Brain Injury Centers ______________________________1.866.966.1020 Domestic Violence Hotline___ _1.800.799.7233 Domiciliary Care—Adult Foster Care 18+ ______Blue pages—County Agency on Aging

Epilepsy Foundation of Eastern PA ______________.wwwefepa.org_1.800.887.7165 Epilepsy Foundation Western/Central PA _______________www.efwp.org, 1.800.361.5885 Head Injury Program -Bureau of Family Health ______________________________1.717.772.2762 Health Law Project—Public health benefits _______________www.phlp.org, 1.800.274.3258 Legal Aid blue pages in your phone book Legal Clinic for the Disabled—Eastern PA ________________________________215.587.3350 Managed Care—Public Health Insurance _______________PDO Insurance,1.877.881.6388 Parent to Parent—Mentoring __1.888.727.2706 Resources for Daily Living—Inglis _____________________www.easiresources.org Self Determination Housing Project _______________www.sdhp.org, 1.877.550.7347 Special Ed Consult Line—PDO Education ______________________________1.800.879.2301 Voting Issues—PDO State 1.877.868.3772 Waiver HelpLine—PDOWelfare 1.800.757.5042 Waivers— Enrollment—IEB 1.877.550.4227

FAMILIES WITH SEVERE ABI/TBI

Does your loved one have a severe brain injury? Kate would like to start teleconference support group meetings for families whose loved ones are not expected to recover. Please contact Kate at 267-731-6035 if you are interested in participating.

Page 5: CHECK YOUR MAIL FOR ABIN-PA’s WINTER APPEAL · include personal assistance and rehabilitation. Get on the list! Call to apply! 877-550-4227 Thank you to Joan Steinberg of Pampered

©2013 Acquired Brain Injury Network of Pennsylvania, Inc. PERMISSION GRANTED TO PHOTOCOPY AND DISTRIBUTE UNCHANGED AND AT NO CHARGE TO ALL WHO ARE INTERESTED.

Interview with Peter Moughan EXTRAORDINARY MINISTER OF HOLY COMMUNION (EMHC)

Pete Moughan always wanted to be a Eucharistic Minister but didn’t have the time.

Then in 2007 he became an EMCH at UPMC Mercy Hospital and now serves communion there to 50 people on Tuesdays & Thursdays.

Six months later he added the Village of PennWood Nursing Home and now serves 33 people there on Wednesdays & Sundays. He will also go to both places on Holy Days of Obligation like November 1st.

This means that Pete serves communion to about 664 people per month! He is very happy with his ministry and hopes to pick up a few additional locations.

ABIN-PA NETWORK NEWS—December 1, 2013—Page 5

Wendy Myers Thanks Bob Neal Wendy thought she would never have the courage to attend a support group meeting, but Bob Neal wouldn't take "No" for an answer and now she takes every opportunity to attend support groups with him whenever and wherever she can.

On Wednesday, December 30, 2013, exactly one year after her accident, Wendy Myers had a wonderful time at the 4 - 5:30 pm brain injury support group meeting at the John P. Murtha Neuroscience and Pain Institute on Scalp Avenue in Johnstown - (814) 266-4700.

This was quite a milestone because all of Wendy's doctors had written her off as "brain injured" and she was never expected to walk or talk. She went from the hospital to a nursing home and stayed there lying in bed for four months. She couldn't move or speak. Staff would put her to bed at 6 pm and maybe get her up for breakfast at 7 am. She never even got the proper rehab and it was too noisy to sleep. She even had a setback when another resident hit her.

Fortunately for Wendy, a staff member at the nursing home, Joanne, took an interest in her and visited her during her personal time. Joanne also introduced her to Bob Neal and both kept visiting and encouraging her. Bob was the first person that talked to Wendy that she could understand. He continued to visit her after she went home and he started taking her to support group meetings. Bob brought her a red mug when hers broke. He brought her a keyboard and at the end of that week she was playing three songs. Bob continues to take Wendy to her doctor's appointments and takes notes for her about the doctor's recommendations. And Wendy found a doctor who cared.

Wendy has a strong message - people with brain injury should only go to nursing homes designed to serve people with brain injury!

Page 6: CHECK YOUR MAIL FOR ABIN-PA’s WINTER APPEAL · include personal assistance and rehabilitation. Get on the list! Call to apply! 877-550-4227 Thank you to Joan Steinberg of Pampered

©2013 Acquired Brain Injury Network of Pennsylvania, Inc. PERMISSION GRANTED TO PHOTOCOPY AND DISTRIBUTE UNCHANGED AND AT NO CHARGE TO ALL WHO ARE INTERESTED.

UNIVERSAL INSTITUTE “Putting the client at the center of our universe.” 

PLEASE HELP ABIN-PA GATHER INFORMATION ON CHILDREN UNDER 21 AND COGNITIVE REHABILITATION THERAPY

ABIN-PA is working with the state to find out whether children under age 21 are actually receiving Cognitive Rehabilitation Therapy under Medical Assistance. Please help by calling, emailing or writing ABIN-PA and describing your child’s experience. We need your help to identify the barriers, as the state is committed to removing them and giving children what they need for recovery.

ABIN-PA NETWORK NEWS—December 1, 2013—Page 6

The mission of Universal Institute is to provide the highest level of quality rehabilitation services to people with 

disabilities in an environment of       

HOPE and DETERMINATION.   

Universal Institute aspires to maximize each individual’s functional capacity and 

self‐worth through comprehensive services such as:  Physical Therapy, Occupational Therapy, Speech Therapy, Cognitive Therapy, Community Integration,  Vocational Services, Day Program,  Residential and Outpatient Services.  

2014 NEWSLETTER & WEB ADS Reach 1,228 subscribers in your target market while supporting ABIN-PA. Newsletters are archived on our website and you will also benefit from monthly distribution of over 500 additional copies by subscribers.

Ads run through December 2014 and a link is available on our homepage. To review the ad agreement, email [email protected]. JPG ad copy preferred. Ad help available.

272 Brodhead Rd., Bethlehem, PA 18017 610‐625‐4959 www.uirehab.com 

ACTION NEEDED ON PENDING STATE LEGISLATION

www.legis.state.pa.us—for bills & legislators HB is a House Bill — SB is a Senate Bill (Bills move between House & Senate)

HB 648—Requires insurance companies to explain their brain injury rehabilitation coverage on request—but it does not require coverage—just information. Please ask your state Representative to support this bill so that families and employers who are shopping for health insurance can choose policies that cover brain injury rehabilitation. This bill is in the House Insurance Committee but will soon be coming back to the House Floor for a vote.

SB 74—Adds penalties for violations of the Safety in Youth Sports Act

SB 136—Creates an independent Acquired Brain Injury Advisory Board

SB 606—Requires one defibrillator (AED) in each school to reverse cardiac arrest

SB 607—Carbon monoxide detectors - the House amended the Senate Bill so please ask your Senator to pass it again!

Type Web Link

12 Issues

1/10 @Mo

Print Ad Width x Height

1/8 No $620 $62 3 7/16 x 2 3/16 1/4 No 1,034 $103 3 7/16 x 4 1/2 1/2 No $1,724 $172 7 1/8 x 4 1/2 1/8 Yes $2,120 $212 3 7/16 x 2 3/16 1/4 Yes $2,534 $253 3 7/16 x 4 1/2 1/2 Yes $3,224 $322 7 1/8 x 4 1/2

Page 7: CHECK YOUR MAIL FOR ABIN-PA’s WINTER APPEAL · include personal assistance and rehabilitation. Get on the list! Call to apply! 877-550-4227 Thank you to Joan Steinberg of Pampered

©2013 Acquired Brain Injury Network of Pennsylvania, Inc. PERMISSION GRANTED TO PHOTOCOPY AND DISTRIBUTE UNCHANGED AND AT NO CHARGE TO ALL WHO ARE INTERESTED.

AS I WATCH MY FATHER PASS AWAY AS I LAY IN MY BED, NOT BEING ABLE TO HELP OUT LIKE MY BROTHERS AND SISTERS AND NIECES, I WATCH THE MAN I LOVE , THE BEST FRIEND I EVER HAD IN MY LIFE, SLOWLY SLIP AWAY TO HIS FIRST AND LAST TRIP TO HEAVEN—TO MEET UP WITH MY MOTHER AND MY SON WHO PASSED AT THE AGE OF ONE. I SIT IN THE HOUSE ONLY BEING ABLE TO GIVE MY KNOWLEDGE OF THINGS THAT I PICKED UP ALONG THE WAY, BEING SHOT AT THE AGE OF 30. I WATCH MY DAD NOT EAT FOR 15 DAYS BUT HE HEARS SOMETHING AND CHIMES RIGHT INTO THE CONVERSATION. I DON’T FEEL LIKE ONE OF THE 6 ANYMORE BECAUSE I REALLY DON’T TAKE CARE OF HIM PHYSICALLY, BUT HE IS HERE AND MY VOICE LIGHTS UP HIS LIFE AND I KNOW THIS. ALL MY LOVE, DAD. YOUR LOVING SON, DANIEL

Daniel F. Rohrback, Jr.

Acquired Brain Injury Network of Pennsylvania, Inc.

2275 Glenview Drive, Lansdale PA 19446-6082 800.516.8052 P: 215.699.2139 F: 215.699.5139

[email protected] www.abin-pa.org

You Can Make a Difference: Volunteer with the Brain Injury Information Line!

One of the most important services that the Acquired Brain Injury Network offers to survivors, family members, and the general community is the Brain Injury Information Line or InfoLine.

Since 2007, ABIN-PA has answered over 1,800 InfoLine calls.

The InfoLine is staffed completely by trained volunteers who provide support, compassion, and information specific to the needs of the individual callers. Volunteers generally find it personally

rewarding because callers are so happy to talk with someone who understands.

Survivors and family members who would like to learn more about the training and support provided to InfoLine volunteers may contact Barb Dively at 800-516-8052, 215-699-2139, or

[email protected].

Help others find the answers:

Become an InfoLine Volunteer.

ABIN-PA NETWORK NEWS—December 1, 2013—Page 7

1-800-516-8052 Free Brain Injury Information

Page 8: CHECK YOUR MAIL FOR ABIN-PA’s WINTER APPEAL · include personal assistance and rehabilitation. Get on the list! Call to apply! 877-550-4227 Thank you to Joan Steinberg of Pampered

©2013 Acquired Brain Injury Network of Pennsylvania, Inc. PERMISSION GRANTED TO PHOTOCOPY AND DISTRIBUTE UNCHANGED AND AT NO CHARGE TO ALL WHO ARE INTERESTED.

ACQUIRED BRAIN INJURY NETWORK OF PENNSYLVANIA, INC. 2275 Glenview Drive Lansdale PA 19446.6082

ADDRESS SERVICE REQUESTED

YOUR MESSAGE TO ABIN-PA—December 1, 2013—Page 8

Date:________Name:__________________________Phone:_______________Need a call?___

Street:____________________________Apt:_____City:________________State:___Zip:________

County:______________________Survivor:___ Family:___ Other:___ Change of Address?___

Email:________________________________________________ Change to email delivery?___

Apartment or Business Name:_______________________________ United Way: #45813?___

PeerConnect: ____(phone or email buddy) Donation canister ___(one per person)

Donation to ABIN-PA: Sending My Check #_______ for $_______. Employer Match____. In Memory Of:__________________________ Person to be notified:______________________ OR In Honor Of:____________________________________________(Honoree will be notified.) Address for Notice:_________________________________________________________Apt:____ City:______________________________State:___Zip:______Other:_________________________

Mail to: ABIN-PA, 2275 Glenview Drive, Lansdale PA 19446.

On-line Store: Wrist Bands, Mugs, Brain Injury Notebook, Brochures, CD’s.

_______________________________________________________________________________________________________________ ABIN-PA is a 501(c)(3) Pennsylvania nonprofit corporation. Contributions are tax deductible.

The official registration and financial information of the Acquired Brain Injury Network of Pennsylvania, Inc., may be obtained from the Pennsylvania Department of State by calling toll free, within Pennsylvania, 1 (800) 732.0999.

NONPROFIT ORG US POSTAGE PAID

LANSDALE PA PERMIT NO. 613