Form Center

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Update Member Information

  1. Please complete the online form below to change your address.
  2. Personal Information
  3. How would most people know you?
  4. Primary phone is: *
  5. Secondary Phone is:
  6. My preferred method of communication is:

    Select all that apply

  7. Please do not contact me using:

    Select all that apply (note this will only apply to robocalls/group messages by the Agawam Council on Aging)

  8. Address Information
  9. Please tell us which housing facility you live in
  10. Do you have a spouse/significant other living with you?*
  11. Are you married to this individual?
  12. If different than yours.
  13. Please let us know how someone might know this individual if they called the Senior Center asking for them.
  14. Leave This Blank:

  15. This field is not part of the form submission.