Membership Application

La Plata Council on Aging, Inc.
2424 Main Avenue
Durango, Co. 81301

970-551-0582

The COA is a non-profit 501(c) (3) service oriented organization that provides support to seniors throughout La Plata County.

Everyone is welcome
Join today and make a difference

2015 MEMBERSHIP FORM   (January 2015 – December 2015)

Date:_______________________________________________________

Name:______________________________________________________

Mailing Address:______________________________________________

City:_______________________________________________________

State: __________________________Zip Code_____________________

Phone(s):____________________________________________________

E-mail Address:_______________________________________________

Amount donated above $2.00 Membership Fee:___________________

Signature:____________________________________________________

Membership Fee is $2.00 per year. Fill out this form and mail it in or drop it off at the Durango Senior Center at the front desk or in the drop box in front of the COA Thrift Store inside. Donations are always welcome and appreciated.

There are several ways to do this without leaving your home.  You may  copy and paste this form into a text document program and print it, fill it out and mail it in.  You may copy, paste and send it to the email address below.  You can click on Membership Form below to download it and then SAVE it to your computer, fill it out and e-mail it to us at the email address below.

A copy of this form is also available in printed form at the Durango – La Plata Senior Center at 2424 Main Ave. in Durango.

laplatacoa@gmail.com

Membership Form