Membership Information Request

Membership Information Request

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Click here for more information on becoming a member. ALL MEMBERSHIPS ARE FREE SO PLEASE CHECK PAY WHAT YOU CAN FOR MEMBERSHIP TYPE!

If you are interested in membership with Ark Valley Helping Hands, please submit an inquiry below or download the application, complete and forward it by email to info@avhelpinghands.org or by mail to P.O. Box 1426, Salida, CO 81201. We will follow up with you as soon as possible.

First name

Last name

Phone

Cell phone

Date of birth

Number

Street

City

State

Zip Code

Available Membership Options

Pay what you can : for 12 months

Individual, Monthly: $20.00 for month

Individual, Annual: $225.00 for 12 months

Household, annual: $250.00 for 12 months

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

First pet species

First pet breed

First pet name

First pet date of birth

Current Health

Mobility issues

Home type

Employment status

Occupation

Your interests what do you love doing

How did you hear about us

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!