Founding Member Enrollment Form

Thank you for becoming a Shtetl 2.0™ Founding Donor - and Member!

Four different suggested donation amounts are listed below, ranging from $36 to $288 for 12 months (one full year).

- If you wish to make a Founding Donation of a DIFFERENT OR HIGHER AMOUNT by credit/debit card, please FIRST use this form to enroll as a Founding Member - and THEN donate the difference to the Founders Fund here. These donations will be combined in your account.
- If you wish to make a Founding Donation of any amount BY CHECK, please contact us for mailing instructions. Checks should be made out to MACSC D/B/A Shtetl 2.0™. Once we have received your check, we will call you and enroll you "on the back end" by phone.

We apologize for this two-step process, which is required by the membership enrollment software, and thank you again for your commitment to our community!

First name

Last name

Phone

Cell phone

Date of birth

Marital status

Gender

Number

Street

City

State

Zip Code

Available Membership Options

1-Spinner: $36.00 for 12 months

2-Weaver: $72.00 for 12 months

3-Carpenter: $144.00 for 12 months

4-Stonecutter: $288.00 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

Mobility issues

Special needs

Home type

Home ownership

Employment status

Vocational/Professional Experience

How long have you lived in the city

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!