Membership Form – Household

Member Information

Optional Demographic Survey

Your OPTIONAL responses to the following questions help Wallingford Community Senior Center receive valuable funding from our sponsoring government entities. We will not, under any circumstances, share your personal information with other individuals or organizations. We do not sell, communicate or divulge your information to any mailing lists. Please respond to the best of your ability. Please scroll to the bottom and click "Submit and Pay Now" if you prefer not to respond.

Please scroll to the bottom and click "Submit and Pay Now" if you prefer not to respond.

Congratulations! You have qualified for a Reduced Rate (free) membership! After clicking "Submit and Now" you may close the pop-up payment tab, as your membership will be completed!