Paul Bunyan Senior Activity Center
Membership Application for Jan 1-Dec 31, 2010
Referred by___________________
Are you interested in learning more about computer
use? YES
NO
Please print. Each person must fill out a separate application
form and each must pay the membership fee.
Name_____________________________________________________________________
Address:__________________________________________________________________
City, State, Zip: ____________________________________________________________
Township:___________________________County:_______________________________
Phone: __________________________E-Mail:____________________________________
Birthdate: ________________________________________________________________
Please check below the category you want for 2010
_____ Patron of the Center at $500 or more
_____Sustaining Membership $250
_____ Friend of the Center at $150 _____Platinum Membership $100
_____Gold Membership at $60
_____Silver Membership at $30
_____Basic Membership at $20
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*
Other:________________ _____Do not wish to volunteer at this time
*Special Rules 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
.