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| 2 <br />Elk River Senior Activity Center Membership Form <br />January 1, 2022 to December 31, 2022 <br /> Annual Rate: Elk River City Resident Discount Rate: <br />__________Individual $37/year __________Individual $26/year <br />__________Dual $51/year __________Dual $37/year <br /> <br /> Checks payable to: City of Elk River <br />Your membership gives you access to the <br />Senior Activity Center at the Furniture and <br />Things Community Event Center. <br />Amenities include: <br />Billiards <br />Coffee Lounge with free coffee <br />Computer Usage <br />Puzzles <br />Lending Library <br />Card and Game Playing <br />Socializing in the Fireside Lounge <br />TV viewing <br />Your membership also includes the ability to participate in the <br />following ongoing groups: <br /> <br />Cards (500, Bridge, Smear, Hand and Foot, Cribbage) <br />Fitness Classes <br />Sewing/Knitting <br />Woodcarving <br />New ongoing groups as they are formed <br />Day passes may be purchased for $5 which <br />will give you access to the listed amenities for the <br />day the pass is purchased. <br />Members receive the monthly newsletter via mail, discount on trips, certain events, classes, and presentations. <br /> <br />Please fill this out completely. <br />1)Member Name:____________________________________Date of Birth:____________________________ <br /> Email:____________________________________________Phone:_________________________________ <br />2)Member Name:____________________________________Date of Birth:____________________________ <br />Email_____________________________________________Phone:__________________________________ <br />Address:__________________________________________________________________________________ <br />City/State/ <br />Zip:_____________________________________________________________________________ <br />By signing I hereby acknowledge that I have read, understand, and will abide by the policies listed in the <br />Participant Handbook. <br /> <br />___________________________________ __________________ <br />Signature Date <br /> <br />___________________________________ __________________ <br />Signature Date <br />Bring this form to: <br />Furniture and Things Community <br />Event Center <br />1000 School Street <br />Elk River, MN 55330