Chai 614 Membership Interest Form

Our new, Jewish-based membership network connects the pre and post retirement Jewish community. Members, with the help of our volunteers, make new social connections, engage in activities, and find help for challenges. It’s an innovative way to make the later life years fun and meaningful and make it possible to age joyfully, purposefully and safely at home.

Chai 614 is based on the growing Village concept which is an innovative way to support seniors. These virtual communities feature volunteer networks that support independent aging through rides to social and learning events, chore services, referrals to existing services in the community and much more.

First name

Last name

Phone

Cell phone

Date of birth

Marital status

Gender

Local village

Race

Ethnicity

Number

Street

City

State

Zip Code

Available Membership Options

Individual - annual: for 12 months

Individual - monthly: for month

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

Employment status

Vocational/Professional Experience

Your interests what do you love doing

Special expertise

How did you hear about us

What made you interested in becoming a 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 contacting us — it’s a pleasure to connect! Our team is committed to providing friendly, professional assistance, and we’ll be reviewing your message right away. You’ll hear back from us soon.