join senior connections
Online registration
A FREE Membership Program for
People 55 & Over
Sign up now for Rome Memorial Hospital's new Senior Connections Program. Senior Connections is our way of saying thank you for your continued support of Rome Memorial Hospital. Our members receive discounts, periodic free health screenings, and advance notice of educational programs. We'll add your name to our mailing list so you are among the first to know about new services available right here in your own community.
Fill in the following information and press the Submit button when finished:
Salutation
First Name
MI
Last Name
Address
City
State
Zip
Phone# (Ex. (315)555-5555)
DOB (Ex. 01/01/1945)
Gender
Ex. - F= Female M=Male
Primary Care Physician
# of Cards Requested
Health Insurance Plan
Click HERE to print out an application
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