SCOSA 2020 Mailing List and Event Registration Form

Question Title

* 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: some programs don't require registration or have alternate registration procedures and are not listed below.

Other, please specify

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* 3. Register for Upcoming Programs: Sessions are in chronological order:
Please enter your name(s) in the box below event you wish to attend. Also, please mark your calendar - we do not e-mail confirmations or reminders.

If the program you're interested in is not listed it may have a different registration procedure. Please check "Older Adult Education" at www.stockton.edu/scosa.

SoulCollage Workshop
10/30/2020 1:30-3pm
ONLINE, A ZOOM LINK WILL BE SENT TO YOU PRIOR TO THE SESSION

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* 4. Under Construction - PLEASE IGNORE THIS ITEM. Register for Specific Program in #3 above and then complete the rest of the survey below.

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.