The Club / Diner Member Application_Feb 2025

Welcome to Wise & Healthy Aging! We're excited to have you join our community.

To get started, complete this application—we’re here to support you every step of the way. A valid photo ID is required for membership and may be uploaded below, or copied at 1527 4th St, Santa Monica. For questions, call 310.394.9871 or email memberservices@wiseandhealthyaging.org.

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* 1. Programs (select all that apply)

The Club: Lifelong Learning for ages 50+. $25 Membership Fee ($15 for Santa Monica residents)

The Diner: Congregate Meals for ages 60+. Free for Santa Monica Residents.

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* 2. Member Info

First Name

Last Name

Address

Apartment / Unit #

City

State/Province

ZIP/Postal Code

Cell Phone #

Email Address

Home Phone #

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* 3. If the address above is temporary, please fill in a permanent address.

Address

Apartment / Unit #

City

State/Province

ZIP/Postal Code

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* 4. Emergency Contact

First Name

Last Name

Cell Phone #

Email Address

Relationship, e.g, Spouse, Friend, Neighbor