Orcas Senior Center · ORCAS SENIOR CENTER MEMBERSHIP FORM

Membership Level Options

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$500 - GOLD PREMIER - couple

$300 - GOLD PREMIER - single

$200 - PRIME - couple

$125 - PRIME - single

$50 - STANDARD - couple

$30 - STANDARD - single

I/We wish to make an additional contribution to support OSC (Please select only one):

$500

$250

$100

$50

$25

$

Contact Information

1st Member NAME

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First Name

Last Name

2nd Member NAME

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First Name

Last Name

1st Member EMAIL

2nd Member EMAIL

1st Member PHONE

2nd Member PHONE

YES! I am interested in volunteering for OSC.

ADDRESS

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

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