Become a Member

Membership is free for adults 55 and older who live in Wilkes County, NC. Fill out your application below — then bring a photo ID when you visit to finish and sign the waiver in person.

Membership Application

🔒 Your application is encrypted and automatically deleted after 30 days. Only center staff can view it, and only until they help you finish in person.

About You

First name *

Last name *

Nickname (optional)

Date of birth

How to Reach You

Phone number *

Cell phone (optional)

Email (optional)

Street address

Town / City

ZIP code

Mailing address (only if different)

Emergency Contact

Someone we can call in case of an emergency.

Name

Relationship to you

Their phone

Health Notes — optional

Completely optional. Share now or tell us in person — whatever you're comfortable with. This stays encrypted.

Allergies

Health conditions or medications we should know about

Mobility or accessibility needs

A Few Last Things

How should we reach you with news & reminders?

I am 55 years of age or older

I live in Wilkes County, NC

Anything else? (optional)

What Happens Next

You submit your application securely.
A staff member calls you to say hello and set up a visit.
You stop by with a government-issued photo ID (driver's license or state ID) to confirm your identity and sign the membership forms and a liability waiver in person.

That's it — and your membership card is ready the same day!

🔒 Your privacy

Your information is encrypted the moment it's saved, viewable only by center staff, and automatically erased after 30 days. We never keep it longer than we need to.

Member Code of Conduct

All members agree to follow our Member Code of Conduct. Please take a moment to review it.

Prefer paper?

You can also download the membership form (PDF), fill it out, and bring it by the center.

Questions? Call us at 336-667-5281.