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Stockbridge Area Senior Center Membership Form
Payment of $20 either cash or check in order to activate membership!
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* Indicates required question
Name:
*
Your answer
Date Of Birth:
*
MM
/
DD
/
YYYY
What SASC programs, activities, and/or classes interest you?
*
Your answer
What would you like to see offered at SASC?
Your answer
Photo Release: I give SASC permission to use my photo and name for promotional purposes. Your typed name represents your signature.
Your answer
Address: (Road, City, State, Zip)
Your answer
Phone Number
Your answer
E-Mail (for SASC communication ONLY):
Your answer
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