BAY AREA SENIOR ADVOCATES (BASA)

MEMBERSHIP APPLICATION/RENEWAL FORM

2009

 DEADLINE:  January 31, 2009*

Thank you for expressing an interest in BASA.  Meetings are held the 3^rd 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

Traverse City , MI 49684

 Updated membership lists will be provided to BASA members at the monthly meetings.  You may email member information changes to gtcoa@grandtraverse.org  .   Only paid members will be included in the listing.  Incomplete membership forms or forms received without a check will not be processed.

 ________________________________________________________________________________________________

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 31^st will not qualify members for Senior Expo discounts.