About Us
News
E-News Signup
Upcoming Events
Contact Us
Staff and Board
Contact for Information
Remembering our Friends
Friends & Co Store
Annual Report
Friendship Services
Visiting Companions
Phone Companions
Coffee Talk
Cards Connect
Let’s Do Lunch & Let’s Do Coffee
Become a Member
Resources
Community Services
Friends & Co to Go
Be A Friend, Volunteer
Become a Volunteer
Current Volunteers
Volunteer Portal
Donate
Search for:
Cards Connect Refer
Are you completing this application for yourself or recommending someone?
Myself
Recommend someone
Participant's Information
First Name
Last Name
Address
include building/facility, unit number
City
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Phone
Phone Type
Mobile
Home
Facility
Email Address (if applicable)
Birth Month
Please select...
January
February
March
April
May
June
July
August
September
October
November
December
Birth Day
Please select...
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Birth Year
Please select...
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Referrer's Information
Please share your contact information with us so we can reach you with questions and let you know when the participant is matched.
First Name
Last Name
Street Address
City
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Agency
Mobile Phone
Home Phone
Work Phone
Preferred Phone
Mobile
Home
Work
Email Address
Your relationship to the applicant
Family member
Friend
Social service provider
Facility staff
Please share why you are making this referral
The participant understands they are being referred, and want to receive cards in the mail. If the participant moves, I will provide Friends & Co with the new address to continue receiving cards.
I agree and will ensure
How did you hear about us?
Hidden fields
-
Arabic
-
ar
Bengali
-
bn
English
-
en
French
-
fr
German
-
de
Hindi
-
hi
Indonesian
-
id
Portuguese
-
pt
Russian
-
ru
Spanish
-
es
