Brandon, Manitoba • Seniors Helping Seniors Since 1982 • 204-571-2050

New Membership Application

New Membership Application

Join the Brandon Seniors for Seniors family today.

Membership Application

Annual membership fee: $35/person. Complete the form below — payment of the fee is required to activate your membership.

First Name *

Last Name *

Email Address *

Phone Number *

Date of Birth

Home Address *

Emergency Contacts

Please provide two contacts we can reach in case of an emergency.

Contact 1

Name

Phone

Email

Contact 2

Name

Phone

Email

Already a member? Renew your membership in the Member Portal.

You can also apply in person at 311 Park Ave E, Brandon MB or call us at 204-571-2050.