Individual Membership Application

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NOTE: This application for membership covers two people per household. Your annual joint membership fee is $15.00. First Applicant ... Mr. Mrs. Ms. First name, last name Date of birth Second Applicant ... Mr. Mrs. Ms. First name, last name Date of birth Joint Information ... Home address County Telephone Please check the category that best describes you ... Wisconsin citizen interested in helping older citizens Professional working with elderly programs I would like to make a tax-deductible contribution to CWAG in the amount of $ Click "send" to submit your application electronically. You will be billed for your membership fee and your donation, if applicable. Or ... print the form, fill it out by hand and "snail" mail it to CWAG. Top of form