Chapters - Become a Member

CHAPTER MEMBER APPLICATION

To submit this application, you may fill it out online, initial the disclaimer, then just click the submit button. Or you can print out a copy, fill it out by hand, and mail it to Significant Living Chapters, 2880 Vision Court, Aurora, IL 60506. You may also email Chapters@significantliving.org to receive a hard copy of this application.

If you have any questions please call 1-866-640-3577 toll free. If we are unavailable, leave a message with your name and phone number and we’ll call you back.

INDIVIDUAL INFORMATION FOR CHAPTER MEMBER APPLICANT

Personal Information for Chapter Records

First Name

Middle Name

Last Name

Street Address

Apt. #

City

State

Zip Code

Country

Home Phone

Cell Phone

Email Address

Personal Web Site

Marital Status: Married Single

Spouse First

Spouse Middle

Spouse Last

Your Birthdate mm/dd/yy

Spouse Birthdate mm/dd/yy

Are you a Significant Living Member?
Yes No

(You are encouraged to become a member of the parent Significant Living organization, with all its benefits within 3 months after joining a Chapter)

What is the primary way you would like us to contact you in the future?

Email U.S. Mail

Church Affiliation

Church Name

Street Address

City

State

Zip Code

Phone

Senior Pastor

Senior Adult Pastor
(if applicable)

Is your church a CASA member church?
(CASA is: the Christian Association Serving Adult Ministries)
Yes No Don't Know

Life Experience

1. Are you a Christian? Yes No

2. If you care to include a short testimony about how you became a Christian you may do so here.

3 List any previous experience (participant or leader) in a group or club environment plus any special small group training you have that would benefit your Significant Living Chapter.

Special Interests

Why do you want to become a Chapter member?

Do you have a special interest that you hope will be your Chapter’s emphasis?
(could be gardening, quilting, arts and entertainment, a specific sport, prayer, special projects, exercise, music, grandparenting, military, travel, or anything you can think of that is particularly enjoyable for you, or you consider a calling)

Is there anything else you want to tell us about yourself including special expriences that would benefit the Chapter and the members?

*Important Disclaimer: Please provide your initials in the area below to allow Significant Living to provide your contact information (name, address, phone, email) only to those attempting to find other members, leaders in their local areas for the express purpose of launching, joining or leading a Significant Living Chapter. Your information will never be sold and will never be given out for any other purpose than that described above.

Initials Here

Thank you for taking the time to fill out this application. We will notify you promptly of our decision to accept your application for membership in a Significant Living Chapter in your area.

Until then . . . keep on celebrating life & faith after 50