Roosevelt Island Senior Association

PERSONAL DATA

First Name:

Short Name:

Last Name:

Birth Date:

Roosevelt Island Address:

Bldg No. Apt No.

Contact address:

Phone

Mobile

Email

Do you have a disability? Yes No

ANNUAL MEMBERSHIP FEE: $15

Category of Membership:

New: 2017

Annual Renewal: 2017

INVOLVEMENT: I have interest in serving as an OFFICER of RISA (Position desired) •

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Available time to serve: Month/Year

 

I have interest in serving as a VOLUNTEER of RISA: (Position desired) •

I can devote FULL TIME (morning, afternoon, evening – choose one or all) •

I can devote limited time (morning, afternoon, evening)