Instructions: Complete the application below. Send the completed application and/or all the specified information to Terry Lynch, Founder ERA. When making your membership please consider a donation of the largest amount you can afford. Thank you!

The purposes and goals of ERA are as follows:

1. To promote the rights, liberty, freedom and independence of elderly Americans.

2. To promote the establishment of legislation which gives all citizens the superior right to specify, designate and appoint their own guardian/conservator, that this right may not be abridged by family members or the Court of any state.

3. To promote a US Constitutional amendment and state constitutional amendments guaranteeing that all citizens may specify, designate and appoint their own guardian/conservator.

4. To serve as an advocate for the rights of senior citizens and elderly Americans.

5. To promote and engage in all forms of activities, business, promotion, service and other human endeavor that is of benefit to elderly Americans, their families and US citizens.

6. To generally support the health, education and welfare of all senior citizens and elderly Americans

7. To promote and organize a grassroots movement across America for the advocacy of elder rights, freedom, liberty and independence.

8. To denounce the warehousing and inhumane treatment of elderly and senior citizens by institutions throughout America.

9. To work for the reform of the elder care system in America

10. To provide an on-line resource, forum or other publications as related to elder rights, health and welfare.

11. To generally do and engage in all activities of benefit to senior citizens and elderly Americans.

12. To extend the above services to all peoples who have a mental or physical challenge and will one day be senior citizens and elderly Americans in benefit of special needs.

    Membership in ERA is open to all people who are in sympathy with the purposes and goals of ERA.

    The ERA shall operate as a private membership organization to which all people may donate their time, money or service. The ERA does not discriminate based upon race, religion, ethnic or national origin, sex or mental or physical impairment or impediment.

    Application

    Yes I am in sympathy with the purposes of the ERA and I would like to be a member of the Elder Rights Association. My membership fee is being made by secure payment via PayPal.com.

    Name: ______________________________________________________
    

    Name of Business:_____________________________________________
    

    Street:_______________________________________________________
    

    PO Box: _____________________________________________________
    

    City: __________________________ State: ______ Zip: ______________
    
    

    Phone: ____________________________ Work:_________________________
    

    Fax:____________________________________
    

    Homepage/URL:________________________________________________
    

    Please check one of the following types of membership:
    

    ____ Individual $15.00 ____ Family $25.00 ____ Donor $50.00
    

    ____ Sponsor $75.00 ____ Patron $100.00 ____ Benefactor $250.00
    

    ____ Gold Benefactor $500.00 ____ Platinum Benefactor $1000.00
    

    Copyright © 2005 by ERA. All rights reserved.