SCOSA 2018 Mailing List and Event Registration Form

Question Title

* 1. Your Contact Information

First Name

Last Name

Street Address

City

State

Zip

Phone (starting with area code)

e-mail address

If employed provide title and organization.

Thank you for using our online form to provide your contact information and sign up for our programs. Your contact information will also be used to send you monthly email and periodic postal service notices of SCOSA events.

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

Question Title

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

Add me to the SCOSA mailing list and send me monthly SCOSA E-Newsletters and occasional e-mail and print updates/announcements.

Correct/change my contact information with SCOSA.

Register for upcoming programs that require preregistration (many don't or have alternate registration procedures and are not listed here). In the list below, please enter registrant name(s) including your own.

Other, please specify

Question Title

* 3. Please enter your name in the box adjacent to each event you wish to attend. Please also mark your calendar for each one you plan to attend as you will not receive e-mail confirmations or reminders. If you don't see the program you're interested in, it may have a different registration procedure. Please check "Older Adult Education" at www.stockton.edu/scosa.

Pickleball
November 14, 19, 21, 26, 28, December , 10. 8:00 am - 10:30 am, Stockton University Sports Center, Galloway, NJ

Time to Tell: Tapping the Source Memoir Writing
10:30 am - 12:30 pm -- monthly on 3rd Saturdays (except October).
Campus Center Meeting Room 1, Galloway, NJ

CANCELLED Merangue CANCELLED
11/16/2018 9:30 am-10:30 am
EHT Nutrition Site
5045 English Creek Ave., EHT, NJ
We hope to reschedule in early 2019

Time to Tell: Tapping the Source Memoir Writing
11/17/2018 10:30 am - 12:30 pm
Stockton University, Meeting Room 1
101 Vera King Farris Dr., Galloway, NJ

Question Title

* 4. Our programs are free unless otherwise noted. We are partially funded under the Older Americans Act of 1965, as amended, which requires that we inform you that we gratefully accept donations for services provided. Donations will support ongoing programming. Also, we are required to collect basic demographic information. 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.

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 programs, please email Gina.Maguire@stockton.edu.