Membership Form


Membership Application

 

Please enroll me as a member of the Parkinson's Support Group of Tarrant County.

(please print this form, fill in the spaces and mail with your payment as directed below)

Date:________________________________

Name:____________________________________________________

Name of Spouse/Family Member/Other:_____________________________________________

Address:__________________________________________________

City/State/Zip:______________________________________________

Home Phone:____________________________Cell Phone:____________________________ 

EMail Address:_____________________________________________

Type of Annual Membership (Check One)

____Individual and Family                                   $20.00 per year

____Professional Member                                  $30.00 per year

____Lifetime Member                                        $200.00 one time fee

Make Check Payable to: Parkinson's Support Group of Tarrant County or PSGTC

Mail to:

Parkinson's Support Group of Tarrant County
P.O. Box 939
Hurst, Texas 76053


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