Application

Membership Application
Membership in the Summit County Senior Services Network is $25.00 yearly. Our membership year runs from January 1 through December 31st. Membership dues are not prorated.

*indicates required fields

*Agency Name:

*Representative 1:

Representative 2:

*Address:

*City:

*State:

*Zip:

*Phone:

*Fax:

*Email:

*Website:

*Agency Director:

*Office Hours:

*Referral Procedure:

*Description of Services:

*How did you hear about us?:

Thank you for joining Summit County Senior Services Network!

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