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To submit a membership form to Amarillo Senior Citizens, you may either fill out the online form below and pay through our online payment option or print the form here and mail it to 1217 S. Tyler St., Amarillo, TX 79101.

Membership Status:

   New Member    Renewal

Marital Status:

   Married    Widowed    Single

Member Name: (First, MI, Last)

Address: (Street, City, State, Zip)

Home Phone:

DOB: (Month/Day/Year)

Age:

Email Address:

Emergency Contact Information:

Name:

Relationship:

Phone:

2nd Phone:

Ethnicity: (optional)

   Black or African American    Hispanic/Latino    Asian
   Caucasian    American Indian/Alaskan Native
   Hawaiian/Pacific Islander

MEMBERSHIP LEVELS

   Basic Individual Member  - $40   Sustaining Member - $50
   Century Club Member - $100    Patron Member - $200
   Lifetime Member - $1000
   *Lifetime Membership can be paid out $100 over 10 months

If you would like to volunteer at the Center, please check your area of interest (s):

   Lunch server   Special Dinners   Bus Tables
   Silent Auction   Snack Bar    Special Events
   Silent Auction   Seasonal Decorating    Other

Member of  (club name) :

Comments:

Enter Security Code: 

Once you have submitted the form above, please click the Pay Now button to be redirected to our secure payment site.