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About
About Our Village
Partners
Villages and OLLI at BCC
Board of Directors
Our Program Director
Newsletter
Covid-19 Information
Helpful Videos - Covid 19
The Village Movement
Members
Volunteers
How You Can Help
Volunteer Manual
Volunteer Forms
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Events
Contact
Membership Application
** Please note, if you are interested in membership but need financial assistance to pay membership fees, please contact us by email at
info@villagesoftheberkshires.org
or call (413) 409-6400**
First name
Last name
email
Phone
Cell phone
Marital status
Please choose...
Divorced
Married
Single
Widowed
Other
Prefer not to answer
Number
Street
City
State
Please choose...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Available Membership Options
Single Person Household ($300 paid monthly): $25.00 per month for 12 months
Two Person Household ($540 paid monthly): $45.00 per month for 12 months
Single Person Household - Supporting Member (Access to newsletters, social events and committee involvement; no volunteer services): $100.00 for 12 months
Two Person Household Supporting Member (Access to newsletters, social events and committee involvement; no volunteer services): $200.00 for 12 months
Single Person Household ($300 paid annually): $300.00 for 12 months
Two Person Household ($540 paid annually): $540.00 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
Current Health
Please choose...
Excellent
Good
Chronic condition that interferes with my daily living activities
Prefer not to answer
Mobility issues
Please choose...
No mobility issues
Walk with cane
Walk with walker
Use a wheelchair
Uses service animal
Need assistance getting in and out of cars
Difficulty with Stairs
Prefer not to answer
Employment status
Please choose...
Full Time
Part Time
Self-Employed
Unemployed
Retired
Occupation
Your interests what do you love doing
Special expertise
How did you hear about us
Please choose...
Email Solicitation
Friend or Acquaintance
Marketing Telephone Call
Meeting or Event
Newspaper or Magazine Article
Online Search (Google, Bing, etc.)
Other
Do you hold an OLLI Membership?
Yes
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!