UC Irvine Healthcare - A Passion for Care. The Power to Cure

Senior Club Registration Form

University of California, Irvine Senior Health Club Registration

To register please fill in all the requested information and click the "send" button.
For assistance or more information please call 1-877-UCI-DOCS.

The Senior Club is open to all people 50 years and older.

first name	middle initial	last name

street address

city	state	zip

area code + phone	e-mail address	health plan

birthdate- month	day	year

comments or questions

Yes, I would like to become a member. Please keep me informed about new senior membership benefits and events.

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