SMAS Membership Application

Senior Men's Association of Stamford

Membership Application
Please Enter Your Information and Submit the form or Print it and bring to a meeting
Date

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nick Name
Marital Status
Spouse or Significant Other Name
Date of Birth*

MonthDayYear
Date
Place of Birth*
Phone Number*
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Email
example@example.com
Vocation (pre-retirement)
Employer (pre-retirement)
Introduced By Member
How did you find out about the Senior Men's Association of Stamford?*
Dues - $80 per year, prorated by Trimester: Jan 1st $80, April 1st $60, Sept 1st $100 (which includes your $80 Dues for the following year) and starting Dec 1st $80 for following year.

Cash or Check. Make your check payable to SMAS

Please identify your Hobby/Sports interests below
Hobby #1
Hobby #2
Hobby #3
Do you like to sing? We have an SMAS Singing Group, the Songters. Are you interested?

YesNo
Do you spend your winters out of state?

YesNo
All members are asked to volunteer to help with food services; to assist with meeting setup/breakdown; to help with our many activities; to serve as Board Members
Emergency Contact Name
Relationship
Emergency Contact Phone Number
Please enter a valid phone number.
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Staff Use Only

Membership Date ___________________________

Date Entered In Database ____________________

Contribution Amont & Date ____________________

E-Mail List _________________________________
Should be Empty:

Senior Men's Association of Stamford