80+Senior Membership

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

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Home Phone

please include your landline number if applicable

(###)

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Please confirm that you are a senior 80 years or older *

Yes I am 80+ years of age

Do you have a website? *

Do you have a website solely for your artwork that you would like included in the RFAA Members Website list?

Yes

No

When is the best time to call you? *

Hour

Minute

Second

AM PM