Paul Bunyan Senior Activity Center
Membership Application for Jan 1-Dec 31, 2012
Please print. Each person must fill out a separate
application form and each must pay the membership fee.
Name_____________________________________________________________________
Address:__________________________________________________________________
City, State, Zip _____________________________________
Phone____________________________________________
Township_________________________________________
Date of Birth_______________________________________
Please check below the category you want for 2012
_____ $200+ Diamond Membership
_____ $150 Sapphire Membership
_____ $100 Ruby Membership _____ $80 Emerald
Membership _____ $60 Amethyst Membership _____ $40 Garnet Membership _____ $30 Turquoise Membership _____ $20 Pearl Membership
Volunteer Opportunities: Please check below any areas you
may be interested in
volunteering at the Center. (You do not have to
volunteer to be a member. This is optional)
_____Bake Sales
_____Greeting Card Recycling
_____Board Member _____Host/Hostess*
_____Building Maintenance _____Nutrition Program
_____Christmas Gift Wrap _____Pancake Breakfast
_____Committee Member _____Senior Chorus
_____Spring Style
Show _____Senior Creations Gift Shop
- Clerk*
_____RSVP
_____Concessions at the Sanford Event Center
_____Other:________________
_____Do not wish to volunteer at this time
*Special Rules and Training Apply
Please attach your check made out to the Paul Bunyan Senior Activity Center
to this
form and either hand it in at the desk or mail it to us. Your cancelled
check will be your acknowledgement. If you would like a Membership Card,
please stop by the Center to pick one up. Note: The Center Board of
Directors has established that gift shop vendors must also be members.
Paul
Bunyan Senior Activity Center
216
Third St NW
Bemidji, MN 56601