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Senior Gold: Become a Member

Nix Senior Gold is a free senior health and wellness program offered to adults age 55 or older. If you or someone you know would like to become a member of Senior Gold, please contact the Senior Gold office at (210) 579-3157, or fill out the on-line application below. Come join us!

Fields marked with a red * are required.
 
 Your Membership Application Information: 
Salutation:  Mr. Mrs. Ms. Dr. Rev.
* First Name: 
* Last Name: 
 
* Address: 
 
* City: 
* State: 
* Zip: 
 
* Email: 
* Phone: 
* Birthdate:  (Example: 08/27/1940)
* Status:  Married Single Widow/Widower
 
 
 Spouse or Other Household Member Applying for Membership: 
Spouse's Salutation:  Mr. Mrs. Ms. Dr. Rev.
Spouse's First Name: 
Spouse's Last Name: 
Spouse's Birthdate:  (Example: 08/27/1940)
 
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Nix Health Foundation
414 Navarro, Suite 1015   San Antonio, Texas 78205-2523   Phone: (210) 579-3158   Fax: (210) 242-3641
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