Membership Information Request

Thank you for your interest in membership to our Village! We are a nonprofit dedicated to helping older adults thrive at home with the support of a caring community. Through our volunteer services, healthy aging wellness programs, and meaningful connections, we empower our members to live independently and with peace of mind.

First name

Last name

Phone

Cell phone

Date of birth

Marital status

Gender

Local village

Race

Ethnicity

Number

Street

City

State

Zip Code

Available Membership Options

CVV – Trial Membership Individual:$120.00 for 3 months ($40.00/mo if paid monthly)

CVV – Trial Membership Household:$165.00 for 3 months ($55.00/mo if paid monthly)

Single:$360.00 for 12 months ($33.00/mo if paid monthly)

Single: $375.00 for 12 months

CVV - Founding Member Individual:$480.00 for 12 months ($40.00/mo if paid monthly)

CVV - Individual:$480.00 for 12 months ($40.00/mo if paid monthly)

Individual:$480.00 for 12 months ($40.00/mo if paid monthly)

Household:$600.00 for 12 months ($50.00/mo if paid monthly)

Household:$600.00 for 12 months ($52.00/mo if paid monthly)

CVV - Founding Member Household:$660.00 for 12 months ($55.00/mo if paid monthly)

CVV - Household:$660.00 for 12 months ($55.00/mo if paid monthly)

First emergency contact name

First emergency contact cell phone

First emergency contact phone

First emergency contact email

First emergency contact address

First emergency contact relationship

Mobility issues

Your interests what do you love doing

Special expertise

How did you hear about us

What interested becoming member

Additional Comments

I confirm that I have read, consent and agree to Revolutionaging’s (Helpful Village’s) TERMS OF USE and PRIVACY POLICY

Thank you for your interest

Thank you for contacting us — it’s a pleasure to connect! Our team is committed to providing friendly, professional assistance, and we’ll be reviewing your message right away. You’ll hear back from us soon.