CCS Individual Membership Form

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Congress of California Seniors

Yes, I want to be a member of CCS. One membership includes spouse. Please allow 4 to 6 weeks for receipt of membership materials. Dues are not deductible for income tax purposes.

Individual / Couple Membership Application

1 year ------ $15.00
3 years ----- $40.00
Lifetime -- $200.00

Enclosed is my check in the amount of: __________

Name _______________________________________________

Address ___________________________________ Apt ______

City ________________________ State ____ Zip + 4 ______________ + _ _ _ _

Phone _________________ E-mail: _______________________

Name of Spouse __________________ Year of Birth _________

Referred By _________________________________________

Please make checks payable to CCS

Mail to: Congress of California Seniors
1230 N Street, Suite 201
Sacramento, CA 95814

If you have any other questions, please call the CCS office at (916) 442-4474.

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Congress of California Seniors
1230 N Street, #201
Sacramento, CA 95814
(800) 543-3352
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