MEMBERSHIP APPLICATION      -- Please print this page and fill it in --

Date:
First Name:
Last Name:
Address:
City:
Postal Code:
Date of Birth:
Place of Birth:
Phone
e-mail
I am the qualifying age of fifty-five (55) years
Arrival in the Yukon:
Date of retirement:
Employment skills before retirement:
Hobbies:
Volunteer ability:	YES:
	NO:
	How often:
Contact in case of emergency:
Name:
Phone:

Membership Fee:     $ 20.00 per year

Calendar Year:        January 1st  -  December 31st

 

__________________________________________________
- Signature -

Please print and mail, e-mail or hand in at the office:

 Golden Age Society
4061 A 4th Avenue
Whitehorse, Yukon Y1A 1H1

      

Golden Age Home

Contact + Board

Membership

Newsletter

Regular Programs

Photo Gallery

Yukon's Golden Girls

Index