Membership Application

Use the application below to apply for membership with Village Collective. Once submitted, your application will be reviewed by our admin and we will reach out to collect payment or ask additional questions.

First name

Last name

Phone

Cell phone

Date of birth

Number

Street

City

State

Zip Code

Available Membership Options

Village Collective Membership: $60.00 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

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!