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Join Now! It’s Easy – Just fill out the form below, and submit your payment.
If you are a new member, fill out the form below,
and click the orange SUBMIT button. Send us your check for the amount indicated.
Renewing Members Click Here
First and Last Name
Spouse’s Name
Full Address (Street, City, State, Zip)
County
Birthdate
Contact Number
Pick One
Caucasian/White
African American
Hispanic
Other
Email Address
Veteran? (Select One)
Army
Navy
Air Force
Marines
Coast Guard
Not a Veteran
If retired, please list company name you retired from
If not retired, please list place of employment
Would you be willing to help on a committee in the future?
Yes
No
How did you hear about the Senior Center?
Emergency Contact #1 (Full name, Relationship, Cell Number)
Emergency Contact #2 (Full name, Relationship, Cell Number)
Read this Waiver
I accept this Waiver
Yes
No
***** Make your check payable to Senior Center of Sidney-Shelby County ******
CLICK HERE TO SUBMIT YOUR MEMBERSHIP FORM
Renew Your Membership Here
First and Last Name
Full Address (Street, City, State, Zip)
Contact Number
Email Address
***** Make your check payable to Senior Center of Sidney-Shelby County *****
CLICK HERE TO SUBMIT YOUR MEMBERSHIP FORM
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