Referral Form - Friends Life Care

Refer Friends or Family

Refer friends or family members, and when one of them enrolls
in a Friends Life Care plan, you will receive a $100 reward. The
more people you refer, the more rewards you can earn. This referral program is our way of saying thank you to loyal members and welcoming new ones.

Please recall that to become a Friends Life Care Member, it is
necessary for your referral to be:

a resident of Pennsylvania or Delaware
aged 40 – 85
in good health and living independently

Fill out the form below to get started:

Referrer (your name)*
First Last
Referrer phone number (your phone number)*
Referrer Email (your email)
Friend's name*
First Last
Friend's phone number*
Friend's email address
Friend's zip code
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