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First name*
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Membership Levels

Membership Level:		$15 Senior Membership (65 and over) $25 Single Membership $35 Family Membership $50-$99 Bronze Membership $100-$249 Silver Membership $250-$499

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Payment method:		Check On-line via Paypal

If you are mailing your payment by check, please send form and payment to: G.R.I.N. P.O. Box 24365 Cleveland, OH 44124

I would like my Golden Seconds Newsletter sent via email to save on postage costs:		Yes No

Volunteer Interests

I would like to volunteer in the following areas:		Booth Work Committees Crafts/Sewing Follow-up Calls Fostering Home Visits Mailing/Stuffing Newsletter Phone Interviewing Special Events Website

I would like to help with transport:		Yes No

I can help transport in the following Ohio Counties:		Ashland Ashtabula Columbiana Cuyahoga Erie Geauga Huron Lake Lorain Mahoning Medina Portage Richland Stark Summit Trumbull Tuscarawas Wayne

Other counties I can transport that were not listed above:

I will drive anywhere in Ohio:		Yes No

I can help with transport the following days and times:

After filling out this form, please click on the �SAVE� button below. After clicking on the �SAVE� button, you will be redirected to a membership confirmation screen. If you are paying for your membership by PayPal, you will also need to click on the following link in order to complete your membership. PayPal Membership Payment. If you are paying for your membership by check, please make your check payable to G.R.I.N. and send to: P.O. Box 24365 Cleveland, OH 44124

THANK YOU for joining G.R.I.N.!