Membership Application Form

Membership Application Form

🖊 Please Note: When you press SEND at the bottom of the Member Application Form, the form will still be there! Scroll to the bottom of the page and check the box that says "I am not a robot" and re-check the box that says you agree to the Helpful Village Terms of Use and Privacy Policy. Then press SEND again. This is an extra security measure to ensure your application submission is not spam. Thanks for your attention to this extra step in the Member Application process.

📞 After you submit this Membership Application Form, our Members Coordinator will contact you for a chat about Nashoba Neighbors and to schedule a home visit to learn more about your needs. During the home visit, you will also receive the Nashoba Neighbors Member Guide.

👏 If you decide Nashoba Neighbors is a good fit for your needs, we will activate your membership and you'll be all set to make your first service request! Welcome!

Thank you for your interest in Nashoba Neighbors. Make sure to sign up for our monthly newsletter, too!

First name

Last name

Phone

Cell phone

Date of birth

Gender

Number

Street

City

State

Zip Code

Available Membership Options

Individual Membership (3 Months):$50.00 for 3 months ($16.67/mo if paid monthly)

Household Membership (3 Months):$80.00 for 3 months ($26.67/mo if paid monthly)

Individual Membership (6 Months):$95.00 for 6 months ($15.84/mo if paid monthly)

Household Membership (6 Months):$155.00 for 6 months ($25.84/mo if paid monthly)

Individual - Annual: $175.00 for 12 months

Individual Membership (1 Year):$175.00 for 12 months ($14.60/mo if paid monthly)

Household - Annual: $300.00 for 12 months

Household Membership (1 Year) :$300.00 for 12 months ($25.00/mo if paid monthly)

Current Health

Mobility issues

Home type

Home ownership

Occupation

How long have you lived in the city

Your interests what do you love doing

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 your interest and we will be in touch with you very soon!