July 11th, 2013

Membership

Membership fees, as established by the Fergus Falls Senior Citizens Board of Directors, are $25.00 per person per year. Members must be 55 years of age and older, and their spouse or caretaker may become a member regardless of their age. A paid membership entitles the member to the monthly newsletter, voting privileges, and reduced prices on activities. All money received from memberships goes into the Senior Citizens Activity Fund.

Please feel free to download the application form below and return it to the Senior Citizens Program at 115 Lincoln Avenue West, Fergus Falls MN  56537 with your membership fee. Your membership card will be mailed when we receive your payment. If you have any questions, call 736-6842.

Fergus Falls Senior Citizens Program, Inc.
Membership Application

$25 ENCLOSED__________     CARD #_____________
(office use)

NAME________________________________________

ADDRESS_____________________________________

EMAIL________________________________________

TELEPHONE___________________________________

BIRTH DATE__________________________________

EMERGENCY CONTACT:

NAME________________________________________

TELEPHONE___________________________________

RELATIONSHIP________________________________

WAIVER: In consideration of the Fergus Falls Senior Citizens Program, Inc. accepting this application, I, for myself, my spouse, my heirs, executors, and/or administrators, release and forever discharge the Fergus Falls Senior Citizens Program, Inc. and its officers, employees, directors, volunteers, agents, servants, and all connected with the Fergus Falls Senior Citizens Program, Inc. of and from any and all rights, claims, demands, and actions of any and every nature whatsoever, for any and all loss, damage, injuries sustained by me or my property at any time. I also authorize the use of any and all photographs taken within the Fergus Falls Senior Citizens Program, Inc. to be used for publicity of the Fergus Falls Senior Citizens Program, Inc. I declare, for myself, and/or my spouse, that I/we am/are physically sound and medically approved to participate in the activities of the Fergus Falls Senior Citizens Program, Inc., and that I have been instructed to get my doctor’s permission before engaging in any activity offered through the Fergus Falls Senior Citizens Program, Inc.

Signature____________________  Date__________

For information on other senior services in the area log onto the MinnesotaHelp.Info website.