Great Falls Senior Center

Interested in joining us as a member of Great Falls Senior Center?  Print the application below, fill it out and mail with your check to Bob Lundegard, c/o Great Falls Senior center, P.O. Box 425, Great Falls, VA 2206.   

 

2017 Membership Application

Great Falls Senior Center       P.O. Box 425    Great Falls, VA 22066

Yes, I want to be a member for the 2017 calendar year.  Please enroll me as an individual Member at the annual membership fee of $15.00.

Name ________________________________________________________________________

Address_______________________________________________________________________

City____________________________________   Sate_____________      ZIP________________

Telephone_________________________________     E-mail_________________________________________

E-mail again for quality assurance_______________________________________________________________

Emergency Contact Person & Telephone Number___________________________________________________

You may join for more than one year.  If you choose multiple years, simply indicate the number of years and adjust  your check payment accordingly, making it payable to Great Falls Senior Center.

I choose to join for  ____  years at the rate of $15.00 per year.

I also choose to provide a donation of $____________ for the support of GFSC programs.

By applying to GFSC, you are agreeing to have your picture used for promotional use by GFSC.

Yes/No (circle one) I would like to be included in the list of GFSC volunteers

If you know of persons who are home bound and in need of companionship please contact Joy Trickett at 703-404-8412, or joygoodshepherd@verizon.net.

 

Great Falls Senior Center is a 501(c)(3) non-profit organization. Post Office Box 425, Great Falls, Virginia 22066

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