Via Christi 50+ membership form

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Via Christi 50+ is a membership program for people 50 and over. A small annual fee ($25 per person, or $40 per couple) entitles you to free or reduced-cost health education classes, screenings, social events, the bi-monthly newsletter, and much more.

Complete this form now to start your membership!

* Indicates required information
Name * 
Email Address 
Street Address 1 * 
Street Address 2 
City * 
State * 
ZIP * 
Country 
Phone 
Birthdate *    (mm/dd/yyyy)
Social Security Number 
YES! I would like to receive e-mail notifications about health information and events from Via Christi 50+ 
Additional Member Information 
Name 
Birthdate    (mm/dd/yyyy)
Social Security Number 
Bill me 
Authentication * 

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Information provided to Via Christi 50+ is secure and confidential.

If you have questions about your membership, call us at 316-689-5700.

 

 
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