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
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