BAY AREA SENIOR ADVOCATES (BASA)
MEMBERSHIP APPLICATION/RENEWAL FORM
2009
Thank you for
expressing an interest in BASA. Meetings
are held the 3rd Wednesday of every month, except in December.
To join BASA, fill out the membership information below.
Make certain all items are completed.
Mail your membership form and a check for $35.00 made out to BASA to:
Disability Network/Northern Michigan--BASA
333 E. State Street
PLEASE PRINT
Organization
Name:______________________________________________________
Member Name &
Title:___________________________________________________
Address:_______________________________________________________________
City:________________________________________________Zip:_______________
Telephone:______________________________Fax:____________________________
Please complete and
return by January 31, 2009 with your check for $35.00.
Members are welcome
to join at any time. However,
checks received after January 31st
will not qualify members for
Senior Expo discounts.