© 2018 - 2019 by Roosevelt Island Senior Association  

 546 Main Street, Box D

New York, NY  10044 riseniorsa@gmail.com

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Tel:  917. 951.4137

Roosevelt Island
Senior Association

Membership Information

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) •

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)

Membership Fee: $15.00

Membership Term: April 2017 through March 2018

If you have questions or want more information please contact:

Barbara Parker 917-951- 4137
Donna Chenkin 516-527- 4746
Diane Lindeman 212-838- 0860