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Membership Application

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SASKATCHEWAN SENIORS MECHANISM

MEMBERSHIP APPLICATION FORM

Click Here to Print the Application

Name of Organization: ________________________________________

Full Mailing Address: _________________________________________

_________________________________________

Postal Code ______________ Phone Number ______________

NOMINEE TO MECHANISM BOARD __________________________

Address _________________________________________

_________________________________________

Postal Code ______________ Phone Number ______________

ALTERNATE NOMINEEE __________________________________

Address _________________________________________

_________________________________________

Postal Code ______________ Phone Number ______________

PRESIDENT OF ORGANIZATION _____________________________

Address _________________________________________

_________________________________________

Postal Code ______________ Phone Number ______________

SECRETARY OF ORGANIZATION ______________________________

Address __________________________________________

Postal Code ______________ Phone Number_ ______________

Amended August, 2006

Membership in the S. S. M. is open to organizations:

a. Whose membership is:

- primarily of seniors (defined as 55 years or older)

b. Which are recognizable as senior directed.

Member organizations of S. S. M. shall consist of the following categories:

1) Organizations which are province wide or city wide in
terms of:

- membership

- goals and objectives

- services and/or programs available throughout the
province or city

- a network throughout the province or city

2) Any seniors organization meeting the criteria in clause 1 of these by-laws, and which

is not represented by any of the existing member organizations of Saskatchewan Seniors Mechanism, may apply for membership in the SSM. Such applications shall

be put to the SSM Board of Directors, and, if approved by the Board, to the SSM Annual General Meeting for ratification.

1) Under which category are you applying for membership?

____________________________________________________________

2) Describe your organization:

a) origin:________________________________________________

_______________________________________________________
_______________________________________________________
_______________________________________________________

_________________________________________________

b) purpose/goals/mission:__________________________________

_______________________________________________________

c) is your organization provincial wide?__________

city wide?_________

d) is your organization incorporated?___________

when?______________________

e) is your organization a registered charity with a registration number for

income tax purposes? Yes___ No____ Charitable No. ________________

f) your fiscal year is from ____________________ to_____________________

g) sources of funding last year_____________________________

_______________________________________________________

Prior to last year________________________________________

_______________________________________________________

h) Activities include______________________________________

_______________________________________________________

i) Major projects_________________________________________

_______________________________________________________

j) Membership:

- Number of members 55 plus_________________________

- Restrictions _____________________________________

- Number of Board members __________________________

- % of Board members who are 55 plus _______________

- % of membership who are 55 plus __________________

- Number of branches, clubs, associations and other

organizational representation_____________________

k) Future plans__________________________________________

_______________________________________________________

l) Other comments______________________________________

_______________________________________________________

Please enclose:

a) a copy of your Bylaws

b) a copy of your last audited statement

Signature _______________________

Date ____________________________

If you have any questions or would like further information, please feel free to contact the office Monday to Friday, 9:00 a.m. to 4:30 p.m.

Highlights

Membership Application