The Ora M. DeJesus Gerontology Center - University of Massachusetts Dartmouth

The Gerontological Society of Southeastern New England at UMass Dartmouth

Yes, I wish to become a member! — My check is enclosed.

Make checks payable to:

The University of Massachusetts Dartmouth

Please check areas of interest:
— Law
— Health Care
— Social Services
— Education
— Advocacy

— Research
— Public Policy
— Economics
— Arts/Activities
— Other ____________

Send completed form to our Treasurer:

G.S.S.N.E. at U.M.D.
Nancy Camara
270 Robert Gray Avenue
Tiverton, RI 02878

Membership Level:

— Individual

– Organizational

If you would like to further support the work of the Society, your tax deductible donation would be appreciated.

$15.00

$75.00

$______

Name_________________________________

Organization ___________________________

Address_______________________________

City/State/Zip___________________________

Home Phone_________-__________________

Work Phone_________-__________________

E-Mail Address_________________________

Would you like to be an active participant in the planning and implementation of future programs? — Yes — No

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