Membership
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.
Membership Rates
Single membership $25
Partner membership $40
Applying for Membership
A candidate for membership must submit an application to the Community and 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________________________________________________
Partner/Spouse’s Name_________________________________________
Partner/Spouse’s Birthday_______________________________________
Favorite Hobbies/Interests_______________________________
________________________________________________________
Emergency Contact Info:
Emergency Contact person ____________________________
Phone # ___________________
Circle Membership Type: New Member
Renewal
I also wish to make a donation of $________to support USSI.
Amount enclosed: $______________________
Mail to: USSI
HC89 Box 592
Willow AK 99688-9707