Wallingford Community Senior Center – 2017 Membership Application Order Number You membership matters! Your tax-deductible membership donations support WCSC programs, helping us to provide free and affordable activities and services. Members vote on bylaws and major organizational changes, elect board members, and receive discounted rates on many program offerings! If dues are a financial hardship, please contact us. Thank you for your continued support! Category Individual Annual Membership - $30.00 Household Annual Membership - $50.00 Low Income Annual Membership (Pay what you can) Here is an additional donation to support WCSC Number of People OneTwo First Name * Address * Last Name * Apt Birthdate * Gender Female Male Other City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Phone 1 * Phone 1 type Home Cell Work Email * Phone 2 Phone 2 type Home Cell Work Send Only e-newsletter Yes No Emergency Contact(s) Name(s) and Phone #(s) In the event of a local emergency (earthquake, flooding, heavy storm. etc) would you like us to attempt to contact you and/or your emergency contact to make sure you're ok? contact in emergency No Yes (only me) Yes (both me & emergency contact) Total Donation Total: Payment Method Check Credit Card Credit Card Number * Exp Month * Expiration Year * Security Code * If paying by check, please mail check to Wallingford Community Senior Center 4649 Sunnyside Ave N, #140, Seattle, WA 98103