Demo Village. A community of seniors supporting each other as they age in their own homes

Number

Street

City

State

Zip Code

Available Membership Options

membership 3 monthly autoextend ind: $40.00 per month for 12 months

membership type 3 household monthly: $45.00 per month for 12 months

membership type 3 household monthly autoextend: $50.00 per month for 12 months

Membership type 4 ind monthly autoextend: $60.00 per month for 12 months

Membership type 4 individual monthly: $66.00 per month for 12 months

Membership type 3: $360.00 per month for 12 months

Subsidized Membership: $0.00 for 12 months

Polina:$10.00 for 12 months ($30.00/mo if paid monthly)

Polina 2:$20.00 for 12 months ($50.00/mo if paid monthly)

Membership Light for Volunteers: $50.00 for 12 months

A-Individual: $50.00 for 12 months

one month: $60.00 for month

Village Membership Dual:$100.00 for 12 months ($10.00/mo if paid monthly)

test 3:$120.00 for 12 months ($10.00/mo if paid monthly)

Instant Individual:$120.00 for 12 months ($10.00/mo if paid monthly)

Household Instant: $175.00 for 12 months

test: $200.00 for 12 months

Individual - monthly:$200.00 for 12 months ($20.00/mo if paid monthly)

Individual: $200.00 for 12 months

Super VIP Pass:$250.00 for 12 months ($20.00/mo if paid monthly)

Household - monthly: $300.00 for month

Membership type 1: $350.00 for 12 months

Membership type 1 monthly autoextend:$360.00 for 12 months ($30.00/mo if paid monthly)

Membership type 1 monthly:$360.00 for 12 months ($30.00/mo if paid monthly)

Household:$468.00 for 12 months ($39.00/mo if paid monthly)

Household:$469.00 for 12 months ($39.00/mo if paid monthly)

Membership type household 2 monthly autoextend:$480.00 for 12 months ($40.00/mo if paid monthly)

Membership type household 2 monthly:$480.00 for 12 months ($40.00/mo if paid monthly)

Membership type household 2: $500.00 for 12 months

Household Full: $515.30 for 12 months

Social: $540.00 for 12 months

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

Second emergency contact name

Second emergency contact cell phone

Second emergency contact phone

Second emergency contact email

Second emergency contact address

Second emergency contact relationship

First pet species

First pet breed

First pet name

First pet date of birth

Second pet species

Second pet breed

Second pet name

Second pet date of birth

Current Health

Mobility issues

Special needs

Home type

Home ownership

Employment status

Vocational/Professional Experience

How long have you lived in the district

How long have you lived in the city

Your interests what do you love doing

Special expertise

How did you hear about us

What interested becoming member

Do you hold an OLLI Membership? Yes

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.

Membership Application Form

Available Membership Options

Additional Comments

Thank you for your interest