Membership Information Request

Interested in just learning more about membership? Click the Contact tab, then Contact Us and select "Memberships" on the contact form. Interested in joining? Please enter your contact information and any other fields you wish to share. If you have any questions regarding the application please contact the office at 607)319-0162. Thank you and welcome to the LLH Community!

First name

Last name

Phone

Cell phone

Date of birth

Marital status

Gender

Sexual orientation

Ethnicity

Number

Street

City

State

Zip Code

Available Membership Options

Household Membership Trial: for 3 months

Individual Trial: $0.00 for 3 months

Individual Membership 10% Discount:$423.00 for 12 months ($35.25/mo if paid monthly)

Individual Membership Annual:$470.00 for 12 months ($39.16/mo if paid monthly)

Household Membership Annual:$595.00 for 12 months ($49.58/mo if paid monthly)

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

Mobility issues

Special needs

Home ownership

Employment status

Occupation

Your interests what do you love doing

Special expertise

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!