Membership
Information
Membership fees, as
established by the Fergus Falls Senior Citizens Board of Directors, are $12.00
per person per year. Members must be 55 years of age and older, and their spouse
may become a member regardless of their age. A paid membership entitles the
member to the monthly newsletter, free notary service, 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
$12
ENCLOSED__________
CARD #_____________
(office use)
NAME_____________________________________________________
ADDRESS__________________________________________________
TELEPHONE______________________ BIRTH DATE_______________
EMERGENCY CONTACT:
NAME____________________________ TELEPHONE______________
RELATIONSHIP_______________________
The following questions have
been designed to develop a membership profile that will help us to serve you
better. Please take time to answer the following questions by filling in the
blanks or circling the correct answer.
GENDER:
male female MARITAL STATUS:
married widowed single divorced
EDUCATION________________________
DO YOU WORK? part time volunteer
ARE YOU
RETIRED? yes
no FIELD OF WORK?_______________________
RESIDENCE:
own home
apartment DO YOU
DRIVE?
yes no
TALENTS/INSTRUMENTS
PLAYED_______________________________________
SKILLS/HOBBIES/INTERESTS___________________________________________
WHY DID YOU BECOME A
MEMBER?_____________________________________
