Wasilla Area Seniors, Inc.

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WASILLA AREA SENIORS MEMBERSHIP APPLICATION

*  Voting members must be fifty-five (55) years of age or older.      

*  Supporting members, any age:  no voting rights.

*  Membership is based on a fiscal year and is renewable each year in June.

*  Dues will be paid prior to August 1st each year to be eligible to vote at the annual meeting in August.

*  Dues are $20 per fiscal year or $150 for a Lifetime Membership, per person.

ALL INFORMATION PROVIDED ON THIS APPLICATION WILL BE KEPT CONFIDENTIAL.
First Name
Middle Name
Last Name
Address Line 1
Address Line 2
City
State
Zip Code
Daytime Phone() -
Evening Phone() -
Birthdate:
Last 4 digits of SS#
Contact in case of Emergency (name and phone number)
Dr. Name:

Please complete the following questions for us. This information assists WASI in obtaining funding and in grant reporting (Answers are voluntary)
First Name
Last Name
What is your ethnic background?
How many are in your household?
Our programs depend on volunteer help and we encourage you to become involved in the senior center. Is there a particular area you'd be interested in helping with?
Periodically WASI distributes to its members a membership phone book. Do you want your name , address and phone number in this book?
Each month in our newsletter, we print the names and birthdays (not year) of those members cewlebrating a birthday that month. We also announce the names at the birthday lunch. Would you like to be recognized in this manner?

THANK YOU AND ENJOY THE FULL BENEFITS OF OUR GREAT SENIOR CENTER.
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Wasilla Area Seniors, Inc.
1301 Century Circle
Wasilla, AK 99654
907-376-3104

For questions about the Senior Center contact  Member Services
For comments & suggestions about this page contact Webmaster

Wasilla Area Seniors, Inc. assumes no responsibility
for the information which is linked to its website.