Membership

There are two classes of USSI membership – senior member and supporting member.

Members are anyone 21 years of age or older.

Persons 80 or more years of age are eligible for lifetime membership and pay no dues, but enjoy all the privileges of a voting member.

Supporting Members are those who are under 55 and who support the principles of the organization. They include groups, individuals, corporations, proprietorships, and officials representing businesses. These members have no voting privileges.

Membership Rates

Single membership $25

Partner membership $40

Applying for Membership

A candidate for membership must submit an application to the Senior. Center. All blank spaces must be filled in; incomplete applications will be returned for additional information.

Applications may be picked up at the Center or using the form below.

Membership becomes effective upon approval by the membership committee and payment of one year’s dues. Membership follows the calendar year January 1 - December 31

USSI Membership Application

I would like to join the Upper Susitna Seniors, Inc.

Membership dues are $25 per person or $40 per couple. Make check payable to USSI.

(Please print ALL information legibly.)

Name ___________________________________________________

Mailing Address _________________________________________

________________________________________________________

City, State ______________________________________________

9-digit zip_______________________- ____________________

Birthday _________/________/__________

month day year

Anniversary_________/________/________

month day year

Home Phone___________________________________________

Work Phone ___________________________________________

Cell Phone_____________________________________________

E-mail________________________________________________

Spouse’s Name_________________________________________

Spouse’s Birthday_______________________________________

Favorite Hobbies/Interests_______________________________

________________________________________________________

Emergency Contact Info: Emergency Contact person ____________________________ Phone # ___________________

Circle Membership Type: New Member

Renewal

Support Member

I also wish to make a donation of $________to support USSI.

Amount enclosed: $______________________

Mail to: USSI

HC89 Box 592

Willow AK 99688-9707