SRHA Senior Discount Verification Form
A $50 senior discount is available for Facility Dues only. To receive this discount, please submit this form each year before paying your dues. Forms are due annually by March 31st. If you have any questions, please contact treasurer@steeplechase.org.
Name
*
First Name
Last Name
Email
*
example@example.com
Steeplechase Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date
Verification Upload
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Please submit an image of a government ID or other proof of age above. You may also email it to treasurer@steeplechase.org or drop off a copy in the SRHA Mailbox at 1925 Furlong Run.
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