Want to Learn More About Village Membership?

Fill out this form and a village volunteer will contact you to scheduling a time to provide information and answer questions.

The steps taken to become a village member include:

Meeting in your home with a village volunteer
Completing a member application
Reading and signing a member Agreement
Paying your annual membership dues

Your Information

First name

Last name

Phone

Cell phone

Date of birth

Marital status

Gender

Address

Number

Street

City

State

Zip Code

Available Membership Options

Full: $480.00 for 12 months Flex: $240.00 for 12 months Full Scholarship 50%: $240.00 for 12 months Flex Scholarship 50%: $120.00 for 12 months Full Scholarship 80%: $96.00 for 12 months Associate / Support: $60.00 for 12 months Flex Scholarship 80%: $48.00 for 12 months Prospective Member

Additional Information

Pet Information

First pet name

First pet species

First pet breed

First pet date of birth

Second pet name

Second pet species

Second pet breed

Second pet date of birth

Current Health

Mobility issues

Special needs

Home type

Employment status

How did you hear about us

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.