New Member Application Form

This section of our WebSite is for people who are interested in joining the Organization.

Please choose your preferred Membership category:
Regular Membership @ $5.00 Per Year - (For Each Person 55 Years of Age and Older)
Associate Membership @ $3.00 Per Year - (For Each Person Under 55 Years of Age)
Life Membership @ $100.00 - (For Each Person 55 Years of Age and Older)

You can send your payment to:
Juniata Valley Senior Citizens, Inc.
Attn: Betty Boonie, Membership Chair
Route #305, PO Box 338
Petersburg, PA 16669

Please fill in the appropriate information fields below being careful not to use the "Enter" key on your keyboard.

Use the "Tab" key or your mouse pointer to move to the specific data entry areas of the form.
Mr. Ms. Mrs. Miss
Name:
Street:
City : State: ZIP Code:

Telephone:

E-Mail:

Click here when you are finished with information input.