SeniorChoice Membership Application


CRMC SeniorChoice strives to provide services that support the emotional, social and physical wellbeing of those of our community who are 50 or better.  

As a member of CRMC SeniorChoice you will receive several great benefits.  

Annual membership fee:  
$25 per person
$45 per couple


CRMC SeniorChoice is not an insurance program.

Please fill out the form below. You may pay your membership fee by credit card or by check.  All information will be kept secure and confidential. For more information you may call our office during business hours at (256) 737-2600.

You may make payments to CRMC SeniorChoice using your credit card account number or checking account routing number in the fields below. All payments are via secure server.

Enter your information EXACTLY as it appears on your billing/account statement; otherwise, it may result in a failed transaction.

Please only click the SUBMIT button at the bottom of the form once. Clicking more than once may result in multiple payment transactions.

Thank you for allowing us to serve you.

Please provide information below as it is listed on your credit card.

* Required Fields

*  

*  

*  

*  

*  

*  

*  

*  

(Ex. 120.00) *  

*  

*  

*