Required fields are marked with asterisks (*)

WISE Membership Form

WISE Mobile Active Living Centre offers free programming for residents in Muskoka 55+. Please complete the Membership Form to access our variety of programs. Please note that some fields are mandatory noted by a * while others are optional. After completion, call or email Seniors Programs to register for the program(s) of interest.

First Name:

Last Name:

Please provide your Mailing Address (including unit number, PO Box, RR#). If you have multiple residences, please list your address in the region of Muskoka..

Town/City:

Postal Code:

Main Phone Number:

Cell Phone Number:

Email Address:

Would you like to receive program information by email?

Yes

Date of Birth:

Would you like to receive a birthday card annually from our Peer Support Committee?

Yes

Please indicate any dietary restrictions - note that meal options may vary based on the selected answers. We do our best to accommodate everyone's needs and appreciate your understanding.

Vegan

Dairy

Gluten

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WISE Membership Form

Emergency Contact Information: