Membership Information Request

Thank you for your interest in Village in the Heights! We will get back to you in 1-2 business days.

First name

Last name

Phone

Cell phone

Date of birth

Gender

Number

Street

City

State

Zip Code

Available Membership Options

Social: $100.00 for 12 months

Individual:$230.00 for 12 months ($17.00/mo if paid monthly)

Household: $400.00 for 12 months

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.