MCCOAA MEMBERSHIP CARD
Member Name(s)
Valid through August 31, 20______
MCC Organization of Active Adults
oaa@manchestercc.edu • 860-512-2840
www.manchestercc.edu/oaa
In partnership with Manchester Community College
Organization of Active Adults
Membership Application
Minimum Age: 50. Dues:$20 per person per 9/1-8/31 college year (no prorations or refunds). Make checks payable to MCCOAA and mail
with completed form (detach membership card) to: MCCOAA Membership, Great Path, MS #16, P.O. Box 1046, Manchester, CT 06045-1046.
Last Name 1
Last Name 2 (only if different)
Address
Home/Cell Phone
Amount Enclosed (no cash)
Email
Check Number
Check Date
City
State
Zip
First Name 1
First Name 2
Select preference:
n
Mr & Mrs
n
Mr
n
Mrs
n
Ms
n
Miss
Select preference:
n
Mr & Mrs
n
Mr
n
Mrs
n
Ms
n
Miss
Gender:
n
Male
n
Female
Gender:
n
Male
n
Female
Date of Birth
____/____/_______
Date of Birth
____/____/_______
Select one:
n
New Member
n
Renewing Member
Would you be willing to serve on the
OAA Board or a committee?
n
Yes
n
No
FILL IN, DETACH AND KEEP THIS MEMBERSHIP CARD.
OFFICE USE ONLY:
Effective Date: ________________ (date postmarked or delivered to OAA or Continuing Education)
