Senior Elite Renew Membership

Use this form only if you are renewing your Senior Elite Society membership.

The Society offers three age groups for adult members. Adult members are classified as Adult (Age 20-59), Senior (Age 60-74) or Senior Elite (75 & up). Age level is based on the age you will turn in the current year, no matter what month.
If you qualify for Senior Elite please provide your year of birth below.

Senior Elite Renew Membership
Classic:
$25, Benefit: Porcelain brooch
Choice:
$70, Benefit: Sterling silver bead
Premier: $85, Benefit: Sterling silver bead and porcelain brooch
Premier Gold Upgrade: $500, 14k gold bead and porcelain brooch

Membership Number to Renew:

Senior Elite Member's Birth Year:

Choose One:
$25.00 Classic Senior Elite Rate One Year

$70.00 Choice Senior Elite Rate One Year

$85.00 Premier Senior Elite Rate One Year

$500.00 Premier Gold Upgrade One Year (14k Gold Bead)


Credit Card or Check Holder's Information:
Name:
Address:
City:
State:
Zip:
Country:
Phone #:
Email Address:

Enter Member's Information Here:
(if different than information above)
Name:
Address:
City:
State:
Zip:
Country:

Donation to the Moss Foundation
One dollar of your membership dues will be donated to the P. Buckley Moss Foundation for Children's Education. This donation may be tax deductible.

P. Buckley Moss Endowed Scholarship Donation
At the beginning of 2007 the Society created the P. Buckley Moss Endowed Scholarship with an initial donation of $20,000. We have challenged our membership to collectively match this donation! Please do your part and make a donation today. Select your chosen amount below. For more information about this scholarship, please click here. Thank you!
$5 Endowment Donation
$10 Endowment Donation
$15 Endowment Donation
Other Endowment Donation

Anniversary Pins
If you have received your renewal notice in the mail, and it notes that you are eligible for any of the anniversary pins you may select which one(s) you would like to order below. If you do not know if you are eligible to purchase any of these pins please contact us and we will let you know. society@mosssociety.org (800)430-1320
Five Year Anniversary Pin $20
Ten Year Anniversary Pin $20
Fifteen Year Anniversary Pin $20
Twenty Year Anniversary Pin $20
Twenty Five Year Anniversary Pin $20
Thirty Year Anniversary Pin $20

Additional Membership Items
As an added benefit for our renewing adult members, Classic and Premier members may purchase one additional adult brooch for $25; Choice and Premier members may purchase one additional bead OR pendant for $62; and All adult members may purchase one junior pin for $20 each year, limit one please. Your membership must be in good standing to purchase additional membership items. Contact us if you have questions. society@mosssociety.org (800)430-1320
Additional Brooch $25, Classic/Premier Members Only
Additional Bead $62, Choice/Premier Members Only, Choose either bead OR pendant
Additional Pendant $62, Choice/Premier Members Only, Choose either bead OR pendant
Junior Pin $20

Notes: