Membership Application for Senior University Georgetown

Please print this application form on your printer, fill out and mail to

 

Membership

Senior University Georgetown

P.O. Box 488

Georgetown, Texas 78627

Or fax to 512/863-0541

 

Please print all information. This form is not e-mailable at this time. Thank you.

 

Date: ___________________________

 

Title: ___ Mr. ___ Mrs. ___ Ms. ___ Dr.

 

Name (print): _______________________________________________________

 

Address: __________________________________________________________

 

City/State/Zip: ______________________________________________________

 

Phone: ________________________ Email: _____________________________

 

I certify that I am at least 50 years of age.

 

____________________________________________________ Signature

 

Please answer the following questions so we can serve you better.

 

___ I would like to receive communication from Senior University via email

 

 

where possible.

 

or

 

___ I would prefer not to receive email from Senior University.

 

 

 

___More than one person in my household is a member of Senior University. .

 

 

We would prefer to receive only one mailing in our household

 

or

 

___More than one person in my household is a member of Senior University.

 

 

We would prefer to receive one mailing for each member.

Comments:

 

 

Mail this form, with your check for $50 to:

Senior University Georgetown, P.O. Box 488, Georgetown, Texas 78627;

512-868-1982; Fax 512-863-0541