Membership Forms

Membership Agreement Form - Fillable PDF

Silver Sneakers Membership Agreement Form - Fillable PDF

Renew Active Medicare Advantage Plan Membership Agreement Form  - Fillable PDF 

Membership Change Form - Fillable PDF

Membership Freeze Form - Fillable PDF

Membership Medical Freeze Form - Fillable PDF

Membership Cancellation Request Form - Fillable PDF

Forms above that do not require payment information/update can be returned digitally to
Please be sure to save the completed document to your device and attach to the email via the saved file. Any required supplemental information (proof of residency, physicians note, etc.) must also be attached. Forms may also be faxed to 860-429-9773.

Common How-To Guides for Online Account Updating: