Membership Submission Form

We are thrilled that you are interested in joining our organization. As a 501(c)3 non-profit organization founded in 1986 and devoted to supporting our senior population through the Dedham Council on Aging and Ames Senior Center, we rely on the efforts of our members to continue our important work. Please fill out this form to become a member or to renew membership and give your annual dues payment of $5.00 plus optional donation to any officer or mail your check only (no cash) to Friends of the Dedham COA, Inc., PO Box 68, Dedham MA 02027-0068.

Name

First Name

Last Name

Email

Phone

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Residential Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address

If different from Residential Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Membership Agreement

By signing this form, I agree to become a member of the Friends of the Dedham Council on Aging, Inc., and support its mission and objectives. I understand that my personal information will be used solely for the purpose of maintaining my membership, providing my requested mailings, and will not be shared otherwise without my consent.

I understand

Photo Release

I understand I will be asked to sign a photo release.

Yes, I understand