SCOSA 2020 Mailing List and Event Registration Form

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* 1. Your Contact Information

First Name *

Last Name *

Street Address *

City *

State *

Zip *

County

Phone: (xxx) yyy-zzzz

e-mail address (necessary to contact you!)

Are you over age 60?

Your contact information will be used to send you monthly email and periodic postal service notices of SCOSA events.

Please remember to click SUBMIT at the bottom of the page so that your information will be recorded.

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* 2. My reason(s) for completing this form today: (Check all that apply)

Add me to SCOSA mailing list
I want to receive SCOSA E-News, occasional e-mail and print updates/announcements.

Correct/change my contact information

Register for upcoming programs
Please Note: Please follow registration information listed in program guide. Most current programs require registration via Zoom. Some others have other instructions.

Other, please specify

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* 3. Register for Upcoming Programs: Please follow registration instructions for the program(s) you are interested in. Due to COVID-19 restrictions, we aren't currently taking registrations here.

Please check "Older Adult Education" at www.stockton.edu/scosa for programs and registration.

TBA

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* 4. Under Construction - PLEASE IGNORE THIS ITEM.

SoulCollage Workshop 7/31/20

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* 5. Basic Information about you:
SCOSA programs are free unless otherwise noted. We are partially funded under the Older Americans Act of 1965, as amended, which requires us to collect basic demographic information from you. Your voluntary answers to the following questions help us determine eligibility for program funding and to secure future funding. Your answers will be kept strictly confidential. Thank you!

We are also required to inform you that we gratefully accept donations for services provided. Donations will support ongoing programming. To donate go to www.stockton.edu/scosa and scroll to the bottom (Supporting SCOSA) section.

Age

If you have any general questions about SCOSA, please email SCOSA@stockton.edu.

If you have any specific questions about any of the Older Adult Education, Socialization, and Recreation programs, please email Gina.Maguire@stockton.edu.

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Question Title

* 1. Your Contact Information

Question Title

* 2. My reason(s) for completing this form today: (Check all that apply)

Question Title

* 3. Register for Upcoming Programs: Please follow registration instructions for the program(s) you are interested in. Due to COVID-19 restrictions, we aren't currently taking registrations here. Please check "Older Adult Education" at www.stockton.edu/scosa for programs and registration.

Question Title

* 4. Under Construction - PLEASE IGNORE THIS ITEM.

Question Title

* 3. Register for Upcoming Programs: Please follow registration instructions for the program(s) you are interested in. Due to COVID-19 restrictions, we aren't currently taking registrations here.

Please check "Older Adult Education" at www.stockton.edu/scosa for programs and registration.