SeniorChoice Membership Renewal

Renew your SeniorChoice Membership online by completing this form.  

Please complete the form below completely to renew your SeniorChoice Membership.

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

You may pay your annual 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.

Enter your information EXACTLY as it appears on your billing / account statement; otherwise, your payment 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.

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