19 Temple Place, 4th Floor, Boston, MA 02111
Phone: 617-426-0804 • Fax: 617-426-0070
Email: Advocacy@MAOAmass.org
Website: www.MAOAmass.org
Kurt Czarnowski, President
Chet Jakubiak, Executive Director
2015 - 2016
Individual Membership
Join – Renew – Donate Today
And Keep Seniors Active in the Mainstream of Life
Frank Manning and a visionary group of senior activists founded MAOA, the first statewide nonprofit senior advocacy group in Massachusetts, in 1969. For over 44 productive years, MAOA
has led the charge to preserve the dignity, independence, and health of seniors their families and
friends. MAOA’s success depends on the active involvement of everyone who understands that
a high quality of life for seniors benefits us all.
MAOA is the right voice for these times.
MAOA enriches the lives of all people through education, advocacy, and action on
the issues that keep elders healthy, economically secure, and engaged in life
Individual Members Receive:

Reduced registration fees at our widely acclaimed conferences. Reduced rate of $5.00 (vs. $45.00)
covers cost of full-day conference, including continental breakfast, lunch, conference materials and
Continuing Education Units (CEU’s) for eligible Social Workers, Nurses, and Licensed Mental Health
Counselors.
 Copies of MAOA publications.

Opportunities to participate in policy forums and research studies.

Volunteer opportunities.
Individual
Membership/Donation Form
Name:
Phone Home:

Work:

Fax:

Email Home:
Email Work:
Home: Address
City:
State:
Zip:
Organization:
Work Address
City:
State:
License Number
 Social Worker  Nurse  LMHC :
Zip:
#
Date of Birth:
SAVE MONEY BY REGISTERING FOR ADDITIONAL YEARS

Senior/Retiree $25 for one year (65 and older)
 Future Senior/Retiree $50 for one year

$45 for two years

$60 for three years

$85 for two years

$130 for three years
 Students $10 for one year
Name of University/College:
Additional Donations
TO HELP MAOA’s ADVOCACY EFFORTS
 Donation of $
Thank you for your support!
Visit our website at www.MAOAmass.org
 Make checks payable to MAOA
Check Number
Total Amount: $
Massachusetts Association of Older Americans
19 Temple Place, 4th Floor
Boston, MA 02111
Any questions regarding your account call 617-426-0804 or email our Database Manager, Gordon Burns, at
gburns@maoamass.org