Page 4 - Resource Book

All contributions are tax deductible as provided by law.
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Signed:

that I must notify Respite Volunteers of Shiawassee if I wish to discontinue the automated payment service.
$ __________. This authority is to remain in full force and effect for at least twelve (12) months which constitutes a one year membership. I understand
Authorization Agreement: I authorize Respite Volunteers of Shiawassee to charge my checking or savings account monthly in the amount of
Monthly Deduction: $

Account Number:

Routing Number: __ __ __ __ __ __ __ __ __
Number
Routing Number

Check
9 Digit
Financial Institution:

Please debit my membership payment from: □Checking Account □Savings Account (check only one)
Date to Start Deductions: (Respite Volunteers of Shiawassee will debit on the 15 of each month)
Address:
City, State and Zip:
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Phone:

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Respite Volunteers of Shiawassee Electronic Funds Transfer Authorization Membership Form
Photo by: Tracey Palmer th E-mail: Photo by: Tracey Palmer Account Number a
The best thing
Our volunteer is a great person. My husband can, at times, be hesitant to who helps, but cares for the volunteer. Our volunteer is family and does a wonderful job. --Betty Bailey This family has become family to me. Volunteering is a very fulfilling experience. You grow to love the ones you help. --Betty Gross Membership Forms Volunteers is the best! Respite about this program is that when a person is fee

Volunteers services
Your donations will help fund
Visits to match volunteer with families

Placement and Supervision ♥ Volunteer Recruitment, Training, ♥ Home ♥ Managing Volunteers ♥ In Home Assessments for Person’s Family Caregivers and Home Safety ♥ Caregiver Support and Education ♥ Promotion of Respite ♥ Case Management and Reassessment ♥ Volunteer Continuing Education ♥ Helping Persons to remain in their home $5000 Black Diamond membership could help provide 10 families services for one year $1000 Diamond membership could help