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Contact Information (*=required)

First name*   
Middle name 
Last name* 
Company name 
Address (line 1)* 
Address (line 2) 
ZIP or postal code* 
Address type 
At least one required
E-mail and type* 
Membership Levels
Membership Level:
   $15 Senior Membership (65 and over)   $25 Single Membership   $35 Family Membership   $50-$99 Bronze Membership   $100-$249 Silver Membership   $250-$499   
Additional Donation Amount:
Total Amount Enclosed:
Payment method:
   Check   On-line via Paypal  
If you are mailing your payment by check, please send form and payment to:
P.O. Box 24365
Cleveland, OH 44124
I would like my Golden Seconds Newsletter sent via email to save on postage costs:
   Yes   No  
Volunteer Interests
I would like to volunteer in the following areas:
   Booth Work   Committees   Crafts/Sewing   Follow-up Calls   Fostering   Home Visits   Mailing/Stuffing   Newsletter   Phone Interviewing   Special Events   Website  
I would like to help with transport:
   Yes   No  
I can help transport in the following Ohio Counties:
   Ashland   Ashtabula   Columbiana   Cuyahoga   Erie   Geauga   Huron   Lake   Lorain   Mahoning   Medina   Portage   Richland   Stark   Summit   Trumbull   Tuscarawas   Wayne  
Other counties I can transport that were not listed above:
I will drive anywhere in Ohio:
   Yes   No  
I can help with transport the following days and times:
After filling out this form, please click on the “SAVE” button below. After clicking on the “SAVE” button, you will be redirected to a membership confirmation screen. If you are paying for your membership by PayPal, you will also need to click on the following link in order to complete your membership. PayPal Membership Payment.

If you are paying for your membership by check, please make your check payable to G.R.I.N. and send to:
P.O. Box 24365
Cleveland, OH 44124
THANK YOU for joining G.R.I.N.!