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q YES! I am interested in the following types of
housing arrangements, products or services for
myself or a family member.

q YES! I would like to receive a FREE copy of the next
SENIOR LIVING GUIDE edition.
Communities Services q End of Life Planning/Funeral
q Active /Independent q Legal/Financial Guidance q Real Estate/Moving Services
q Assisted Living q Adult Day Care q Legal/Financial Guidance
q Rehab/Skilled Nursing q Hospice/Palliative Care q Home Health/
q Alz/Memory Care q Medical Equip/Supplies Companion Care
q Hospitals/ Physician Care
I am most interested in this general area: q South Carolina–Statewide
q North Carolina: q Virginia:
q Piedmont NC- Charlotte Metro & q Hampton Roads q Central
Surrounding Counties q Florida:
q Triad NC- Greensboro/Winston- q Central q South q West Coast
Salem/High Point
q Triangle NC- Raleigh/Durham/Chapel Hill
Name ____________________________________________________________
Address ___________________________________________________________
City _______________________________________ State ____ Zip ___________

Best phone number where you may be reached ___________________________________
Email ____________________________________________________________
Pet(s) name _____________________________________ I am a veteran q Yes q No
I am looking for information for q Myself q My parent q A relative q A friend
Your age group (optional) q under 50 q 50–59 q 60–69 q 70–79 q 80+
I plan on making a decision in q 1–3 months q 3–6 months q 6–12 months q over 1 year
I obtained my copy of Senior Living Guide at ____________________________________
For information on communities nationwide visit www.seniorlivingguide.com
For an online version of our books visit www.seniorlivingguide/ebooks
To mail this in to receive a free copy of any of our books send to:
Fairfax Publishing Company • 14 Pidgeon Hill Drive, Suite 330 • Sterling, VA 20165
Fairfax Publishing LLC · PO Box 1622 · Sterling, VA 20167

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