Ageless Dreamer® - Dreamer Dream Request

Make a Dream Request

If you know someone, seventy years or better, and is a U.S. Citizen, who has an ageless dream and shares 'an attitude worth having®' please let us know. Although it is impossible to know which dream requests will become a reality, we will do our very best to respond to every one received.

Ageless Dreams we can not fulfill:

-Requests for home renovations, RV rentals and cash

-Requests for cruises and travelling outside US

-Requests for vacations, cars, or boats

-Requests to purchase medical equipment

-Requests to provide medical treatment

Dream Requests are reviewed on a regular basis and applicants are notified via phone, mail, or email as to the status. Response times may vary depending upon the dream request. Once a decision has been made, you will be requested to have a simple referral form completed by a: clergy member, lawyer, Rotarian, Assisted Living/Independent facility or nursing administrator, social worker, or someone in the field of medicine.

Yes! I know someone with an ageless dream.

Fill out the form below, or download a mail-in dream request form, to let us know.

The * marking indicates a required field.

Your Information

First Name *
Last Name
City *
State *
Zip Code *	5-digit zip code
Phone *	###-###-####
Email
Relation to Dreamer *

Dreamer's Information

First Name (or Initial) *
Last Name (or Initial) *
Year of Birth *
Male/Female *
Brief Description of the Dream *
Brief Description of Physical Limitation (if applicable)