Membership Information Request

Thank you for your interest in Village in the Heights! We will get back to you as soon as possible.

Your Information

First name

Last name

Phone

Cell phone

Date of birth

Gender

Address

Number

Street

City

State

Zip Code

Available Membership Options

Household: $400.00 for 12 months Individual: $230.00 for 12 months ($17.00/mo if paid monthly) Social: $100.00 for 12 months

Additional Information

Current Health

Mobility issues

Special needs

Home type

How did you hear about us

What made you interested in becoming a 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.