Please fill out and submit this form to receive a free information packet about Friendship Village of South County.

Name

Address 1

Address 2

City State Zip

Home Phone Number

Cell Phone Number

Email Address

I would like information about: (check all that apply)

Independent Living Assisted Living Skilled Nursing Care

This information is for: Myself Father Mother

Friend Other Relative Other

Do you know anyone who lives here now?

Yes No

What size apartment would you be most interested in?

Alcove One Bedroom

Two Bedroom Cottage

Please call me and schedule a tour of Friendship Village