New York StateWide Senior Action Council Membership Application
Type of Membership
Individual Membership $20/year
Lifetime Membership/Individual $150
Organizational Membership $75/year
Couple Membership $25/year
Lifetime Membership/Couple $200
Choose Membership Type
Are you a New or Renewing Member?
New Member
Renewing Member
Name
*
First Name
Last Name
Name #2 (for couple membership)
First Name
Last Name
E-mail
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
*
Chapter (if known)
Phone Number
*
-
Area Code
Phone Number
IMPORTANT NOTE:
When you hit the submit button, it will take you to the Network for Good Website for your payment.
For the question - Please share with this charity
- do not click on the anonymous option. We need to know who the donation is from.
If you would like to pay by check for your membership, please mail the check to: NY StateWide Senior Action Council
c/o Gail Myers
46 Commonwealth Dr
Glenmont, NY 12077
THANK YOU!
Submit
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