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            Belgrade  Senior  Friendship  Center

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Membership Form

Belgrade Senior Center, 92 East Cameron Ave.,

Belgrade MT 59714

Dues are $12.00 per year

Date____________________________

Name____________________________________

Address__________________________________

City/State/Zip____________________________

Phone___________________________________

Birthdate _______________________________

Membership: New_____ Renewal_________

Payment: Cash_________ Check________

 

  The Senior Center has more current information.

CONTRIBUTIONS

YES, I (We) would like to make a donation in the amount of $_______________

_____My Check is enclosed (payable to BSC)

_____Cash is enclosed

Address: __________________________________________________________________

City: ______________________________________ State: _____________ Zip: ________

I wish to make a gift (please check one)

_____To Support Belgrade Senior Center

_____In Honor of__________________________________________

_____In Memory of ___________________________________________

_____Other______________________________________________________

Please send a memorial card to:

Name___________________________________________________________________

Address _________________________________________________________________

City _____________________________________ State______________ Zip_________

Your gift is tax-deductible to the extent provided by law.

 

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