Richland Seniors Association

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Membership Form

RICHLAND SENIORS ASSOCIATION
MEMBERSHIP FORM - YEAR 2019

Show your support (at any age): Members will receive monthly Newsletters that highlight coming events and are welcome to attend monthly Board of Directors meetings and semiannual General Membership Meetings. Monthly Board meetings are held in the Meeting Room at the Richland Community Center (“RCC”), 500 Amon Park Drive, Richland, WA 99354 on the second Thursday of the month from 10:00 AM to Noon. The General Membership meetings will occur at times to be announced in the monthly Newsletter. Please support our Association by becoming a Member.

NOTE: Dues paid after September 1 by new members or renewing active members will result in paid membership through December 31 of the following year.

[ ] New Member: I can be an active member. (please check one)
Will help at [ ] Dances [ ] Fundraisers [ ] Gift Shop [ ] Would like to volunteer
[ ] I will be unable to participate actively.

[ ] Renewing Membership: I am an active member. (please check one)
Will help at [ ] Dances [ ] Fundraisers [ ] Gift Shop [ ] Would like to volunteer
[ ] I will be unable to participate actively.

Enclosed is my payment for 2019 dues in the amount of $5.00 per person.

NOTE: In an effort to continue our dues at the lowest rate possible, we welcome any voluntary donations ($10, $25, $50.…whatever you can afford).. Please help!!


PRINT Name(s)________________________________________ Total Dues ($5 each)
Street Address _______________________________________ $_____________________
City/State/Zip_________________________________________ Donation
Phone:______________________________________________ $_____________________
Total Amt. Enclosed: $_____________________

We can reduce our printing costs with your help--by sending your Newsletter by email. AND…you will enjoy your Newsletter in color.

[ ] YES, please send to my E-mail address:________________________________________________

Please provide your Birth Date/Anniversary so we can publish it in our Newsletter.
It is not necessary for you to indicate the YEAR of birth.

His Birth Date ________________ Her Birth Date_______________ Anniversary Date____________
Give anniversary year, if you wish!

I have used the following RSA technologies: [ ] website (http://www.richlandseniors.com/ )
[ ] Facebook (RSA Richland Seniors Association)

Please make checks payable to: Richland Seniors Association or RSA

And SEND to: Treasurer
Richland Seniors Association
PO Box 1356
Richland, WA 99352
Rev. 01/2019

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