Give the Gift of StateWide

Give the Gift of StateWide

Show your loved one you care about their future, give them a StateWide membership this holiday season.
Donor's Name*

First Name Last Name
Donor's Phone Number*

Area Code Phone Number
Donor's E-mail
example@example.com
Type of Membership*
Choose Membership Type
Name of Recipient*

First Name Last Name
Name of Recipient #2 (for couple membership)

First Name Last Name
Phone Number*

Area Code Phone Number
E-mail
example@example.com
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
County*
When you hit the SUBMIT button, it will take you to the Network for Good Website to pay for the membership. If you would like to pay by check, please mail the check to:

NY StateWide Senior Action Council
c/o Gail Myers
46 Commonwealth Dr
Glenmont NY 12077
How would you like to pay for your gift?*

Pay onlinePay by check
Should be Empty: