Acknowledgment of Requirements |
NEW MEMBERS ONLY: I have read and understand the duties and obligations of an Active Member.
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Status |
New Member or Renewed/Renewing for "year" - fiscal year is June to September, e.g 2025-2026
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Membership |
Active Member - $120 (NEW MEMBERS may only join as Active or Student), Student - $25, Sustaining Member - $150 (*must have been Active 5 years), Life "Active" or Life "Sustainer" $100 (by previous Life designation only)
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Last Name |
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First Name |
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Address |
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City |
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State |
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Zip Code |
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Home_Phone |
If applicable; example 305-123-4444; *** enter at least one phone number Home, Cell or Work ***
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Cell_Phone |
example 305-123-4444
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Work_Other_Phone |
example 305-123-4444
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Email |
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Birth_Month_Day |
mm dd, mm=3 char Month, dd=day; Example: Aug 20 for August 20
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Emergency Contact # |
Optional. Enter name, relationship, phone number of family member or friend to be contacted in case of emergency; example: Husband, Bob, 305-123-4444; NOT for publication; accessible to Membership Chair, Technology Chair only
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Interests |
Active Members - Indicate preference(s) of at least one committee and/or project to serve on (please limit to 3 max); **Sustainers may select "Sustainer-NoCommittee" if they do not wish to participate
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Co-Chair |
Would you consider serving as co-chair for:
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Host |
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Consent Signature |
Enter your name as CONSENT TO PHOTOGRAPH AND PUBLISH -
The undersigned agrees The Villagers, Inc. and media may use digital images, negatives, prints, or video from such photographs (still or video) for the purpose of information, education and publicity, including without limitation posting on websites, Facebook, social media, etc. I hereby waive any right to compensation for such uses. By entering your name, you are indicating agreement.
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(New Member) Why are you joining The Villagers? |
NEW MEMBERS PLEASE COMPLETE
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(New Member) Please name any Villagers you know |
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