Friends of Dennis Senior Citizens Membership

July 1, 2009 - June 30, 2010

Membership Dues Form....

Annual dues: $7.00 per person - $14.00 per couple. Life membership dues: $75.00 per person

Is this a new membership? _____ Or a renewal? _____

Please print

Name: Mr.____ Mrs.___ Ms.___ _________________________________________

Mailing address _____________________________________________

Street address _______________________________________________

Town, State, Zip code __________________________________________

Telephone #: (______) ____________________

E-mail address _________________________________

Amounts enclosed: Annual Dues ..............$___________

Life membership dues .............................$____________

Tax Deductible Donation (optional) .......$_____________

Total enclosed ............................ $_____________

Please make check payable to: Friends of Dennis Senior Citizens, Inc.

Mail to: Friends of Dennis Senior Citizens, Inc., PO Box 287, South Dennis, MA 02660

Please include a self-addressed stamped envelope for the return of your membership card, or come into the office in person.

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