Author: activity coordinator

Mason County Senior Activities Association

All Mailings: P.O. Box 1066 Street: 190 W. Sentry Drive
Shelton, Washington 98584
Phone: 360-426-7374 Fax: 360-426-1955
www.mcsac.net

2017 Membership Application and Agreement
Welcome! We hope you enjoy making new friends and participating in our many activities, classes, trips and volunteer opportunities. MCSAA Members enjoy great benefits including:
Our excellent Active Living Newsletter every month
Free birthday Lunch on the third Friday in the month of your Birthday
Birthday listing in the Newsletter and recognition on the Birthday Board the month of your Birthday
Discounted Pricing on most trips and classes
Exclusive access to some Center Classes, Trips & Functions
Discount at our Nifty Thrifty Thrift Store
Your emergency information on file in case it is needed (it has been before)
Annual Dues are $30 per person, due each year by January 31st. Membership is for those 50 or better, however, spouses of a 50+ member, that are not yet 50, may join as an Associate (non voting) member. Make checks payable to M.C.S.A.A. (Mason County Senior Activities Association)
Please, PRINT all information CLEARLY
FIRST NAME:_____________________________________MIDDLE____________________________
LAST NAME______________________________________NICKNAME__________________________
DATE OF BIRTH: ______/________/_______ ð Male ð Female PHONE: _______._____.______
CELL______-______-_______ EMAIL ADDRESS _______________________________@____________
Check One: I prefer to receive my monthly Active Living newsletter by Regular US Mail ð
Please save the cost of US Mail and email my Active Living newsletter ð
I want to save MCSAA Postage, I’ll see Active Living on their web site ð MAILING ADDRESS: _______________________________, __________________, ______, zip________
In Case of Emergency ( Please fill this optional information out. Our members who have needed us to call for help have been thankful that they did) Name:____________________________ Relationship________________
Phone #: _______.________._________ Cell _______.________.__________
Physician _____________________________ Phone #: ______._______.______
*All Information is kept confidential but is useful for reporting anonymous statistics for Grant applications and other funding. Your cooperation is most appreciated.
Hold Harmless Agreement: I freely and knowingly assume the risks inherent in my participation in all activities, including all classes, travel and volunteer duties. I do hereby agree to indemnify, release, and hold Mason County Senior Activities Association, a WA non-profit corporation, doing business as Mason County Senior Activities Center & Nifty Thrifty, it’s employees, volunteers, officers, board members and other persons or organizations harmless from and against any and all liability for any injury, loss of property, damages, or death, which may be suffered by me, or my Guests, arising out of, or in any way connected with volunteering or participating in any activities at the Center, Center sponsored activities at other locations, or while traveling with the Center, in the Center’s bus or under it’s auspices. Specifically, I understand that Mason County Senior Activities Association provides no medical insurance, and that I am responsible for the cost of treatment for any injury to me or my Guests.
Furthermore, I acknowledge that I am being strongly advised to consult a licensed physician prior to my participation in the activities that I have chosen, to determine their suitability and safety given my current medical condition. In addition, I acknowledge that MSCAA is not responsible for reminding me of activities that I have signed up for.
Photos/Video/Audio Release: I am aware that the Center activities are occasionally photographed by Center representatives the media and others, and that still photos, and/or audio and video recordings may be made to help promote the Center’s non-profit mission, and fundraising efforts. I hereby give my permission for me to be photographed and recorded while participating in Mason County Senior Activities Association activities.
Thank you for joining… Your membership dues help provide services and programs to the Mason County Community. We are completely self funded by Nifty Thrifty, Pavilion Rentals, Members, Donors & Sponsors.
Signature ___________________________________________ DATE:_____/ _____/ 201__

Last Name, First _____________________________________ Member #___________ New Member ð Renewal ð Key Tag X_______________

Volunteers are the Heart and Soul of our Center.
If you would like to volunteer your talents to our organization, please check those areas where you would like to help below.
Volunteer Questionnaire
Activities of interest or Skills you Possess– Please check all that apply & fill in any blanks that apply
Serve on the MCSAA Board
Membership (or other) Committee
Newsletter Publication
Web Page updates
Social Media Sites/Updates
Teaching Computer Classes: Beg/Inter or Adv
Teach ___________ Class (fill in your skill)
Teach Genealogy Class
Teach a Health/Diet/Nutrition Related Class
Teach a writing class
Teach a ______________ exercise class
Reception Desk (answering phones, taking money, trips, registering new members)
Host (Make Coffee/tea/ maintain treats & utensils)
Cook/clean/prep for Friday Lunches
Pavilion Event Chaperone
Volunteer to help with Special events
Cook/clean/prep for Special Events
Decorate/Set up for Special Events
Book/Provide entertainment
Newsletter & Flyer distribution
Newsletter folding, sealing & mailing
Bingo Caller/set-up/take down/Karaoke Host
Provide Haircuts at the Center
Potluck Help
Decorate the Center for seasonal cheer
Make Crafts to sell or decorate
Photography (take pictures at events and of Members)
Trip Driver (must have clean driving record)
Volunteer to help with Special events
Community Ambassadors
I hereby authorize a background check to be done for insurance
Signature ___________________________________________ DATE:_____/ _____/ 201__

Volunteer to help with Special events
Facility Management
a. Electrical
b. Plumbing
c. Carpentry
d. Handyman/Repairs
e. Painting
f. Janitorial
g. Garden/Grounds
Clerical/Secretarial
a. Data Entry
b. Letter Writing
c. Posters & Forms
d. Emails
f. Excel/Word/Publisher
g. Transcribe Minutes/ Take Dictation
Miscellaneous
a. Legal
b. Grant Writing
c. Fundraising
d. Budgets/Bookkeeping
e. Event Planning & Organization
f. Finance & Accounting
Your Ideas: ___________________________
______________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Last Name, First__________________________________ Member #_____________ New Member ð Renewal ð Key Tag X______________

All Mailings: P.O. Box 1066 Street:190 W. Sentry Drive
Shelton, Washington 98584
Phone: 360-426-7374 Fax: 360-426-1955
www.mcsac.net

Name________________________________ Member #_____________ New Member ð Renewal ð Key Tag X_______________

Name________________________________ Member #_____________ New Member ð Renewal ð Key Tag X_______________