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©2015 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 April 1, 20152015/#0499th Issue 215.699.2139, 800.516.8052, Fx: 215.699.5139 2275 Glenview Drive, Lansdale PA 19446.6082 [email protected] www.abin-pa.org “Empowering Survivors and Families to Rebuild Their Lives.” Last Call for Registration! CELEBRATE & CONNECT: ABIN-PA’s 8TH ANNIVERSARY PHILADELPHIA LUNCHEON Saturday, April 11, 2015 11:30 AM3:30 PM GUESTS: Representative Tom Murt Representative Tim Briggs SPEAKERS (See page 3): Managing Your Money Mary Beth Morgan, Liberty Resources Recovering Thru Music Joe Romano, Music Therapist Epilepsy After Brain Injury Susan Bolno, Epilepsy Foundation REGISTRATION DUE NOW! USE FORM ON PAGE 10 or Call. REGISTER ONLINE by credit card. only SCHOLARSHIPSmake your request by phone or email ([email protected]). EXHIBITORS & SPONSORS Print form online or request by email. Also looking for Door Prize, Silent Auction & Basket Raffle Items CROWNE PLAZA PHILADELPHA WEST 4010 City Avenue, Philadelphia PA 19131 (215) 458-2123, www.cpphilawest.com INDEXIN THIS ISSUE 1. Philly & Pittsburgh Luncheons; Index 2. Events; March Board Meeting 3. Philadelphia 4/11 Speakers; Donors 4. Greetings; Resources 5. Pittsburgh 5/30 Speakers; ABIN-PA Roster 6. Frustration; Ad Rates; Funding; Mission 7. PA Veterans’ Benefit; Homeopathy 8. HealthChoices Medicaid Expansion 9. Children’s Rehabilitation 10. Register; Sign Up; Donate SHOP AT AMAZON SMILE —— CHECK ABIN-PA HomePage Register by May 23rd! CELEBRATE & CONNECT: ABIN-PA’s 8TH ANNIVERSARY PITTSBURGH LUNCHEON Saturday, May 30, 2015 11:30 AM3:30 PM SPEAKERS (See Page 5): Constance Haber, DC - Chiropractic, Interactive Metronome, Thermography Betsy Reiling, MPH, CCH - Homeopathy Hans Lessman, OD - Mobilize Your Recovery By Improving Functional Vision Awards, 50/50, Silent Auction, Basket Raffle (Donations Welcome!) MENU: Veggies & Assorted Dips, Cucumber & Tomato Salad with Fresh Mint, Braised Brisket of Angus Beef with Molasses Based Barbeque Sauce, Pecan Crusted Baked Chicken, Penne Tossed in Fresh Marinara Sauce, Macaroni & Cheese, Fresh Vegetable Medley, Freshly Baked Cookies CLASS Building, Swissvale 1400 Braddock Ave., Pittsburgh PA

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©2015 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 April 1, 2015—2015/#04—99th Issue 215.699.2139, 800.516.8052, Fx: 215.699.5139

2275 Glenview Drive, Lansdale PA 19446.6082

[email protected] www.abin-pa.org

“Empowering Survivors and Families to Rebuild Their Lives.”

Last Call for Registration!

CELEBRATE & CONNECT:

ABIN-PA’s 8TH ANNIVERSARY

PHILADELPHIA LUNCHEON

Saturday, April 11, 2015

11:30 AM—3:30 PM

GUESTS: Representative Tom Murt

Representative Tim Briggs

SPEAKERS

(See page 3):

Managing Your Money

Mary Beth Morgan, Liberty Resources

Recovering Thru Music

Joe Romano, Music Therapist

Epilepsy After Brain Injury

Susan Bolno, Epilepsy Foundation

REGISTRATION DUE NOW!

USE FORM ON PAGE 10 or Call.

REGISTER ONLINE by credit card. only

SCHOLARSHIPS— make your request by

phone or email ([email protected]).

EXHIBITORS & SPONSORS Print form online or request by email.

Also looking for Door Prize, Silent

Auction & Basket Raffle Items

CROWNE PLAZA PHILADELPHA WEST

4010 City Avenue, Philadelphia PA 19131

(215) 458-2123, www.cpphilawest.com

INDEX—IN THIS ISSUE

1. Philly & Pittsburgh Luncheons; Index

2. Events; March Board Meeting

3. Philadelphia 4/11 Speakers; Donors

4. Greetings; Resources

5. Pittsburgh 5/30 Speakers; ABIN-PA Roster

6. Frustration; Ad Rates; Funding; Mission

7. PA Veterans’ Benefit; Homeopathy

8. HealthChoices Medicaid Expansion

9. Children’s Rehabilitation

10. Register; Sign Up; Donate

SHOP AT AMAZON

SMILE ——

CHECK ABIN-PA

HomePage

Register by May 23rd!

CELEBRATE & CONNECT: ABIN-PA’s 8TH ANNIVERSARY

PITTSBURGH LUNCHEON

Saturday, May 30, 2015

11:30 AM—3:30 PM

SPEAKERS (See Page 5): Constance Haber, DC - Chiropractic,

Interactive Metronome, Thermography

Betsy Reiling, MPH, CCH - Homeopathy

Hans Lessman, OD - Mobilize Your Recovery

By Improving Functional Vision

Awards, 50/50, Silent Auction,

Basket Raffle (Donations Welcome!)

MENU: Veggies & Assorted Dips, Cucumber & Tomato

Salad with Fresh Mint, Braised Brisket of Angus

Beef with Molasses Based Barbeque Sauce,

Pecan Crusted Baked Chicken, Penne Tossed in

Fresh Marinara Sauce, Macaroni & Cheese, Fresh

Vegetable Medley, Freshly Baked Cookies

CLASS Building, Swissvale

1400 Braddock Ave., Pittsburgh PA

©2015 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—April 1, 2015—Page 2

EVENTS

April 11—Philadelphia Luncheon—pg. 1, 3

April 27—Norristown Area Brain Injury

Support Group, 6:30—8:00 pm, Mercy

Suburban, DeKalb Pk (near Germantown)

May 14—Plymouth Meeting Friends

School—Using Homeopathy to Recover

from Brain Injury, Peter Prociuk, MD. pg. 7.

May 30—Pittsburgh—ABIN-PA’s 8th

Anniversary Luncheon—pg. 1, 5

June 20—Blue Bell—Military Families

Appreciation Day—Free—includes lunch.

Montgomery County Community College.

Come to our table!

Sept—Walk/Run/Roll ???

ABIN-PA’S MARCH

BOARD MEETING

Board Members Present: Barry Childress, Barb

Dively, Erikka Johnston, Tom Kisling,

Madelaine Sayko, Joan Steinberg.

Others Present: John Dively, Jean Hurd,

Sheryll Poris.

1. Presentation by Jean Hurd—discussion on

future directions for ABIN-PA as to staff,

space, and funding.

2. February closing balance $18,830.59.

3. PayChex details to go to QuickBooks.

4. 990 EZ—awaiting filed copy.

5. Family Services Lease expires June 30,

checking around for any options.

6. Received copyright for Handbook.

7. Sent report to Inglis on ACE utilization.

8. Volunteer Structure Workgroup—Barb to

prepare report of two meetings.

9. March —1,336 newsletters sent.

10. Plastic Wallet Cards ordered.

11. Brain Injury Coalition planning legislative

breakfast—Barb sent draft handout.

12. Brain Injury Coalition met with legislative

staff on Safety in Youth Sports study.

13. March 10—Crisis Intervention Training for

Police. Northampton Community College

14. March 11—Coatesville VA—Info table.

15. March 13—UPenn conference—Info table

16. March 18—Meeting at Salus University

17. April 16—Anna Marie Childress to testify at

Office of Long Term Living Budget hearing

at the Capitol in Harrisburg.

18. June 4—Lebanon ADRC LINK.

BOARD MEETING SCHEDULE 2-4 pm, Sundays by Phone

Call-in: 857-216-6700 PassCode:127105

Apr 19, May 17, Jun 14, Jul 19, Aug 16,

Sep 20, Oct 18, Nov15, Dec13

PLEASE ATTEND!

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

Cognitive Rehabilitation Therapy

Rooted in

Hope

Results

Achievement

©2015 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—April 1, 2015—Page 3

THANK YOU

TO OUR DONORS!

FEBRUARY

Barry Childress, John Dively, Robert

Drucker, Kay Rowe, Mark Steinberg,

Mary Webb

MARCH

Robert Drucker, Anthony Fasano, Jean

Hurd, Elizabeth Morrisey, Margot Teleki,

Peggy Vietro

CORPORATIONS

Merck Foundation

Hanover Twp. Community Center

LUNCHEON SPONSORS

Silver—Beechwood NeuroRehab

Copper—Goodsir Chiropractic

ABIN-PA LUNCHEON SPEAKERS

APRIL 11th—PHILADELPHIA

Mary Beth Morgan, Liberty Resources -

Managing Your Money to Meet Your Goals

Liberty Resources provides classes in Financial

Management to help people with disabilities

“increase knowledge and skills in handling

money, budgeting, using bank services,

proper credit and debit card use, maintaining

records, filing tax returns, obtaining insurance,

and protecting assets from fraud and theft.”

Use your money to reach your goals. www.libertyresources.org

Joe Romano, Developmental Music -

Stimulating Your Brain To Recover

From Dr. Steve Gallop, a speaker at our

October 2014 Alternatives Conference, “Joe

combines music with movement, visual

processing and other techniques he created,

to help people enhance their visual

information processing abilities. Joe has

enhanced the quality of life of many people

struggling with developmental, behavioral

and learning challenges.” http://vision-therapy-pa.com/blog/

b_30373_my_friend_joe_romano.html

Susan Bolno, Epilepsy Foundation -

Managing Epilepsy After Brain Injury

About 40% of those who experience a

traumatic brain injury will have a seizure at

some later point in their lives. These seizures

are frequently different from what people

expect. Nevertheless, “If you or someone you

love has epilepsy, you may be wondering how

it affects day-to-day life. Will this keep me from

doing the things I enjoy most? How will it

impact my family, relationships, work or

school? In order to live a happy and full life it’s

important to learn how epilepsy can affect

you, what your rights and responsibilities are

and how to find support & resources.” http://www.efepa.org/

©2015 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—April 1, 2015—Page 4

Greetings!

Lots happening this month—many phone

calls asking for information, getting ready for

the Philly luncheon, visiting properties to see if

we can find a slightly larger office, and

working on increasing the availability of

children’s rehab.

Also almost ready to share information on our

new volunteer application process— a

criminal background search, application,

interview, references, and passing an open-

book test after a short training course.

Our Norristown Area Brain Injury Support

Group finally met again after two snow

months! Working toward our individual goals,

exchanging ideas, and learning about the

brain. Enjoying bug juice & cookies thanks to

Mercy Suburban Hospital!

Barb Dively

RESOURCES

ABIN-PA InfoLine 1.800.516.8052

ACA healthcare.gov 1.800.32825.96

Adult & Sr. Protective Services 1.800.490.8505

Aging/Disability Resource Ctrs 1.866.286.3636

Area Agency on Aging (county) Blue Pages

Brain STEPS (Intermediate Unit) Blue Pages

CareerLink (employment services) Blue Pages

Centers for Independent Living 1.717.920.0530

Client Assistance (OVR, CIL’s) 1.888.745.2357

Consumer Protection (state) 1.800.441.2555

Crime Victims Compensations 1.800.233.2339

Defense/Veterans Brain Injury 1.866.966.1020

Disability Rights Network 1.800.692.7443

Domestic Violence Hotline 1.800.799.7233

Epilepsy Foundation-Eastern 1.800.887.7165

Epilepsy Foundation-Western 1.800.361.5885

Head Injury Program (state) 1.717.772.2762

Health Law Project—phlp.org, 1.800.274.3258

Housing—sdhp.org 1.877.550.7347

Legal Aid (low income) Blue Pages

Legal Clinic for the Disabled 1.215.587.3350

Meals on Wheels mealcall.org

Medical Assistance 1.866.542.3015

Medicare Coverage 1.800.633.4227

(Parts A & B have in-home services)

Medicare Denials 1.800.322.1914

Social Security 1.800.772.1213

Special Education Consult Line 1.800.879.2301

Special Kids Network 1.800.986.4550

Vocational Rehabilitation Blue Pages

Voting Issues 1.877.868.3772

Waiver Enrollment-PA IEB 1.877.550.4227

Waiver HelpLine (state) 1.800.757.5042

Women’s Law Project-Eastern 1.215.928.9801

Women’s Law Project-Western 1.412.281.2892

©2015 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 ROSTER

Board President—Barbara Dively

Vice President—Barry Childress

Treasurer—Megan Herlihy

Secretary—Erikka Johnston

Directors Tom Kisling, George Matwiejczyk, Dan

Rohrback, Madelaine Sayko,

Joan Steinberg.

Staff Executive Director—Barbara Dively

Information Technology—John Dively

Payroll—Megan Herlihy

Voice Messaging—Anna Marie Childress

Clerical Employee—Joyce Shaffer

Advisory Panel Gene Bianco; Michael Durst, Esq.;

Tom Felicetti, PhD; Jean Hurd, PhD;

Shannon Juengst, PhD; Roger Margulies;

Elaine Seiler.

ABIN-PA NETWORK NEWS—April 1, 2015—Page 5

ABIN-PA LUNCHEON SPEAKERS MAY 30th—PITTSBURGH

Constance Haber, DC - Chiropractic,

Interactive Metronome, Thermography Dr. Haber has practiced in the Pittsburgh area

since 1965. She has additional certifications in

biofeedback therapy, pain management,

acupuncture and Chinese medicine and is on the

post-graduate teaching faculty at the National

University of Health Sciences. She has four US

patents for her work in photon therapy and has

four Institutional Review Board Supervised Studies. www.ampmcenter.com/about.html

Betsy Reiling, MPH, CCH -

Homeopathy “I realized my calling as a

Homeopath after I

contracted tropical illnesses

while serving in the Peace

Corps in Africa. Conventional western medicine

could only offer me toxic treatments that weren’t

effective. My search for a non-toxic solution to my

illness led me to discover the power of

homeopathy. This experience taught me the

value of health, and respect for our bodies innate

ability to heal.” www.betsyreilingwellness.com

Hans Lessman, OD – Light & Vision Therapy “Our independent program offers a unique blend

of vision, light, and cognitive therapy. We believe

vision can improve and you along with it.”

visiondevelopmentinstitute.com/eye-exam. Light

therapy (syntonics or optometric phototherapy)

has been used clinically for over 70 years in the

field of optometry with continued success in the

treatment of visual dysfunctions, including

strabismus (eye turns), amblyopia (lazy eye),

focusing and convergence problems, learning

disorders, and the aftereffects of stress and

trauma. In recent years, Syntonics has been shown

to be effective in the treatment of brain injuries

and emotional disorders.” www.collegeofsyntonicoptometry.com

©2015 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—April 1, 2015—Page 6

2015 NEWSLETTER & WEB ADS

Reach 1,324 subscribers plus 550 each month.

Archived on website. Shared on expo tables.

Ad agreement on request. Fee for formatting.

FRUSTRATION By Denise Patterson

Don't you get frustrated when you aren't

understood?

Let's say you want to order some food at a

restaurant. Whoever is taking your order

might get it wrong. That can be very

frustrating!

Let's say you are at a doctors office. If you

are not understood, not only can it be

frustrating, it can be life-threatening!

See, when you can't talk, you get more

frustrated.

I have a very hard time talking. Maybe

because for the last 20 years I haven't done

much talking.

It started because I didn't like my voice.

Now, after all these years of not talking, I've

kind of gotten stuck.

Well, see it's a little easier for me because I

know finger spelling, for deaf people. And I

taught my family the sign language

alphabet.

Frustration can be a hard thing to deal

with. You have to try and relax!

If you have a computer, you can look on

the internet to try and find different

techniques for relaxing. For example, yoga.

Or sit quietly with no distractions. You can

meditate.

I hope that helps alleviate some

frustration.

Page

Size

Web

Link

11

Issues

Print Ad

Width x Height

1/8 No $665 3 7/16 x 2 3/16

1/8 Yes $965 3 7/16 x 2 3/16

1/4 No $1,109 3 7/16 x 4 1/2

1/4 Yes $1,409 3 7/16 x 4 1/2

1/2 No $1,849 7 1/8 x 4 1/2

1/2 Yes $2,149 7 1/8 x 4 1/2

Web Only $800 Name/Logo 6wds

ASSISTANCE & REHABILITATION

HEAD INJURY PROGRAM—717-772-2762

- TBI only, age 21+, $100,000/1 year max.

WAIVERS—877-550-4227—lifetime

- CommCare (TBI only, age 21+)

- Independence (any disability, 18-59)

- OBRA (18-59, any disability that begins

before age 22).

©2015 Acquired Brain Injury Network of Pennsylvania, Inc.

PERMISSION GRANTED TO PHOTOCOPY AND DISTRIBUTE UNCHANGED AND AT NO CHARGE TO ALL WHO ARE INTERESTED.

PA VETERANS’ BENEFIT

Veterans or their eligible beneficiaries must

apply by August 31 to receive a special one-

time payment of $75 to $5,000 from the

Commonwealth of Pennsylvania for those

who were on active duty in the Persian Gulf

of Operations from August 2, 1990 to August

31, 1991.

The payment is $75 per month of active

service for a maximum of $525. There is an

additional benefit of $5,000 for prisoners of

war or death during “active service.”

If you know a veteran of Desert Storm and/or

Desert Shield, please share this information

with them or one of their family members.

For details, call toll-free at 866-458-9182 or go

to: www.persiangulfbonus.state.pa.us.

ABIN-PA NETWORK NEWS—April 1, 2015—Page 7

USING HOMEOPATHY TO

REVERSE BRAIN INJURY

May 14: 7:00—9:00 p.m.

Peter Prociuk, MD. Dr. Prociuk spoke at our October 2014

Alternatives Conference in Philadelphia. He is

is a licensed physician (M.D.) with Board

Certification in Internal Medicine and

maintains a homeopathic practice

in West Chester, PA

www.drpeterprociuk.com

MEETING LOCATION:

Plymouth Meeting Friends School

2150 Germantown Pike

Plymouth Meeting PA

www.pmfs1780.org

©2015 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—April 1, 2015—Page 8

HEALTHCHOICES MEDICAID EXPANSION UPDATE March 2015—See www.HealthChoicesPa.com for more info.

The Department of Human Services (DHS) is expanding its Medicaid program, also

known as Medical Assistance (MA). Eligibility rules will not change. Adults 21 years of

age and older will transition into a single new Adult benefit package. The health

screening tool will be eliminated.

In the last week of March, current MA recipients will be notified by HealthChoices

Managed Care Organizations and DHS that they will transition to the new Adult

Benefit package on April 27.

On April 27, Private Coverage Option (PCO) recipients who were covered by MA in

December 2014 will move to MA and receive notices. On July 28, all remaining PCO

recipients will move to MA and receive notices.

On April 27, MA recipients currently in the Interim Healthy and Healthy Plus plans will

move to the new Adult benefit package.

©2015 Acquired Brain Injury Network of Pennsylvania, Inc.

PERMISSION GRANTED TO PHOTOCOPY AND DISTRIBUTE UNCHANGED AND AT NO CHARGE TO ALL WHO ARE INTERESTED.

INCREASING ACCESS TO CHILDREN’S REHABILITATION By Barbara Dively

As you may be aware, Pennsylvania deems all disabled children under age 21 to be

Medicaid-eligible. As a result, federal Medicaid law requires Pennsylvania to provide all

necessary services under its Early & Periodic Screening, Diagnosis & Treatment (EPSDT)

definition, specifically in section1396dr5.

Unfortunately, ABIN-PA discovered that children under 21 were not receiving all necessary

services for brain injury rehabilitation. Instead, children were being accommodated within the

schools under BrainSTEPS and referred to behavioral health for services.

In contrast, brain injury rehabilitation is provided under physical health care through licensed

Occupational, Physical, and Speech/Language Therapists. Specifically, in 2005, CPT 97532 or

Cognitive Rehabilitation Therapy (CRT) was determined to be evidence-based for cognitive

recovery by BlueCross BlueShield. Pennsylvania is providing this service to adults under the PA

DOH Head Injury Program (since 1985) and more recently under three DHS OLTL Medicaid

Waivers—Independence, OBRA, and Commcare.

Our investigation revealed that physical healthcare providers were not willing to have

occupational therapists provide CPT97532 to children under 21 unless that billing code was

included in the Medicaid State Plan. As a result, ABIN-PA asked the Office of Medical

Assistance Programs to add CPT97532 to the Medicaid State Plan in September of 2013. One

year later, in September 2014, the state responded that MA would pay for CPT97532 by a

licensed occupational therapist for children under 21.

Since then, ABIN-PA has not been able to find any occupational therapists who provide

CPT97532 to children or any children who receive CPT97532 under Medical Assistance as

outpatients. In fact, ABIN-PA has not located any professionals, children’s programs, or parents

who are aware of the need for ongoing rehab follow-ups to age 21 to maximize normal brain

development after this devastating injury. In addition, Montgomery County has been routinely

referring juvenile delinquents to behavioral health care without screening for brain injury.

Fortunately, the Department of Health brain injury screening project in Montgomery and Bucks

Counties is revealing that 50% of court-involved children have had a traumatic brain injury—

and Montgomery County Children, Youth & Families staff will soon be trained in brain injury.

The next goal is to connect children automatically to brain injury rehabilitation so that parents

see a path to recovery. We don’t’ want parents to choose mental health services over brain

injury rehabilitation—as was recently reported to me by a school district social worker.

Currently, ABIN-PA is polling graduate programs across the state and finding some allies

interested in promoting CPT97532 by OT’s for Medicaid-eligible children. We have also

reached out to the Pennsylvania Occupational Therapy Association which is contacting its

members, and to the Special Needs Coordinators in MA physical health across the state.

ABIN-PA NETWORK NEWS—April 1, 2015—Page 9

©2015 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

REGISTER, SIGN-UP, DONATE—April 1, 2015—Page 10 Mail to: ABIN-PA, 2275 Glenview Drive, Lansdale PA 19446.

* You can also register, donate or sign up for the newsletter online at www.abin-pa.org.

Date:_____________Name:____________________________________Phone:______________________

Address:______________________________________________City:________________State:___Zip:____

Apartment /Business:______________________________________ Survivor:___ Family:___ Other:___

Email:___________________________________________________ County:__________________________

*DONATION: Check #________ for $_________ Employer Match_____ United Way: #45813_____

In Memory Of:___________________________ Person to be notified:_____________________________

OR In Honor Of:___________________________________________________(Honoree will be notified.)

Address for Notice:_____________________________________City:______________State:___Zip:_____

PLEASE REGISTER ME FOR 4/11Philadelphia Luncheon Check #_______ Amount $________

____$85 Regular _____$55 Survivor _____$55 Family Member _____$20 Low Income

I need a scholarship because: _____________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________ 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. Registration does not imply endorsement.

NONPROFIT ORG

US POSTAGE PAID

LANSDALE PA

PERMIT NO. 613