Senior Services for South Sound

This form is for new memberships. If you are renewing an existing membership, please use this form.

Membership Level:

Silver ($60)

Silver - Couple ($100)

Gold ($120)

Gold - Couple ($200)

Lifetime ($1,000)

Lifetime - Couple ($1800)

Seasonal ($20)

Check this box if you wish your membership to automatically renew.

First Name: Last Name: Email: Home Phone: Home Address: City: State: Zip: - Emergency Contact Name Emergency Contact Relationship Emergency Contact Phone

If you wish to make an additional donation, please enter it here: $50
$100
$250
$500
$1,000
$2,500
$5,000
Other Amount: :

Membership Application