ASCA Member Registration

JOIN ASCA TODAY

If you are interested in joining the Arizona Senior Center Association, complete our online registration form below; the process will allow you to pay your dues securely using your credit card. Please note that your membership will not be approved until payment is confirmed.

Alternatively, you can fill out the ASCA Membership form and then mail it with a check to the address given on the form.

Contact ASCA today

Please feel free to contact us today if you have any questions about ASCA membership, or would like to learn more about the services we offer.

Step 1 of 2

Your Details
Name*
First Last
Title
Email*
Phone*
Password*
Please choose your password to access the Member areas.
Enter Password Confirm Password
Senior Center Details
Senior Center Name/Company Name*
Center Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address
Please provide mailing address if different to the Center Address

Same as previous

Street Address Address Line 2 City State ZIP Code
Email
Website
Phone*
Fax

Membership Details
Choose Membership Type*
- Individual $25
- Senior Center $50
- Organizational $100
- Association $50
- Retiree/Student $10
Additional Members
For Senior Centers, please add information for 2 additional members. 3 total.
For Organizational, please add information for up to 5 additional members. 6 total.
Member Name 2
First Last
Member Email 2
Member Name 3
First Last
Member Email 3
Member Name 4
First Last
Member Email 4
Member Name 5
First Last
Member Email 5
Member Name 6
First Last
Member Email 6
Payment Details
Membership Total
$0.00
Credit Card Billing Address*
Same as Center Address

Street Address Address Line 2 City State ZIP Code
Credit Card
Card Details
Cardholder Name
Comments
This field is for validation purposes and should be left unchanged.

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ASCA Member Registration

JOIN ASCA TODAY

Contact ASCA today

Step 1 of 2

Your Details

Senior Center Details

Membership Details

Additional Members

Payment Details

Contact Information

Quick Links

Member Links

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