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Upcoming Events

• Free Hearing Screenings-3/10/2010

• Body Recall-3/10/2010

• Body Recall 2-3/10/2010

• Computers-3/10/2010

Lastest News

Congratulations to Our Senior Winter Games Winners!
We would like to congratulate everyone that participated ... Read More

Blood Pressure Checks
The Grand Blanc Senior Center offers FREE blood ... Read More

Email Updates

Call Our Office @ (810) 695-3202 info@gbseniorcenter.org

Membership

MEMBERSHIP ONLINE APPLICATION

Suggested $10 Donation

To become a member online simply fill out the form below. If you would like you may also download the membership form, fill it out, and return it to the office.

1) Name:*	Last	First		Phone

2) Name:	Last	First		Phone

Address: *	Street or PO Box #	Apt. #	City	Zip
Township:*		City		County

What company do/did you work for? What is/was your occupation?


PHYSICIAN*			PHYSICIAN
Dr. Phone #*			Dr. Phone #
Hospital*			Hospital
Marital Status*			Marital Status
Birthday*			Birthday
Age*			Age
Gender*	Male Female (Please select one)		Gender	Male Female (Please select one)
Diagnosed medical problems:		Diagnosed medical problems:

ANNIVERSARY DATE: Emergency contacts: please list two relatives or friends

Name:*		Relationship:*		Phone:*
Name:		Relationship:		Phone:

PLEASE CHECK ALL THAT APPLY: I WOULD LIKE TO VOLUNTEER ON AN OCCASIONAL BASIS FOR:

Special Events	Event Set up/Clean up	Bulk Mailings
Outdoor Beautification	Fund-raising	Maintenance/Repairs
Office/receptionist	Bingo
Advisory Council	Computer Teacher Assistants

I WOULD BE WILLING TO SHARE WITH OTHERS:

A Hobby: A Skill:

A Talent: A Vocation:

Online Account Information:
If you already have online account please enter your email/ password, or if you are a new member please create your own account. Email:* Password: * (Create you own) I have online account

Suggestions/Ideas:
* Denotes Required Field

Why the new form? When applying for grants or funding, we need this data to share when filling out those applications. Thank you for your support!