Herkimer County Blooming Health Communications Form

This is the Office for the Agining Communications Program Sign-Up Form for the Office of the Aging.

Please complete the online form and submit it to our office.

You will receive updates on events, programs and services in your community.

Please fill out this form to sign up for the Office for the Aging Communications Program.

Name:

Phone:

Email:

Mailing Address:

City:

ZIP Code:

Language Preference:

Contact Preference:

Please complete this form verification.

Herkimer CountyOffice for the Aging CommunicationsSign Up Form