Lakeland Retirement Foundation - GENERATIONS 

Membership Form

Please print, fill out and return to our office with your $30 per person membership dues.

Last Name: ____________________________________

Husband First: __________________________________

Wife First: _____________________________________

Cell Phone: ________________________________________

Home Phone: ______________________________________

Mailing Address:  ________________________________

County: ______________________________________

Town: _______________________  Zip: _____________

Email: ________________________________________

Emergency Contact: _____________________________  Phone: _______________________

Birthday Husband: ______________________   Wife:  _______________________________

Are you a year-round resident?    Yes / No

Winter Mailing Address:  ________________________________________________________

Are you interested in volunteering?  ________________________________________________

Interests / hobbies: ___________________________________________________________