Name #1
*
If everyone calls you Bob, but your name is Robert, put in "Bob."
First Name
Last Name
Email address for #1
*
Phone number for #1
*
The best number to reach you
(###)
###
####
Secondary Phone Number
If your cellphone is primary but you have a landline as well, you can enter that number here.
(###)
###
####
Gender of #1
*
Date of birth of #1
*
MM
DD
YYYY
Emergency Contact Information for #1
*
Full name of contact, phone number, email address, city & state. Please use someone outside of your household. If none, type in "none"
Name #2
*
First Name
Last Name
Phone number for #2
(###)
###
####
Secondary Phone number
If your cellphone is primary but you have a landline as well, you can enter that number here.
(###)
###
####
Gender of #2
Date of Birth of #2
*
MM
DD
YYYY
Emergency Contact Information for #2
*
Full name of contact, phone number, email address, city & state. Please use someone outside of your household. If none, type in "none"
Wintergreen address of this household
*
If you use a PO Box, put your street address in Address 1 and the PO Box Address info in the Address 2 field.
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
What year did you move to Wintergreen?
*
Why are you interested becoming a member of Here to Stay in Wintergreen?
*
What are your needs and expections? Some members have very specific needs, others are looking ahead with non-specific concerns. Some members are just joining to stay involved, informed or to be supportive.
Anything else we need to know?
You can expand on any of the questions in the space below or offer your ideas on services or programs.
THANK YOU for your application. If you have any questions, please email membership@HereToStayWTG.org.
This is the first of three steps to becoming a member of Here to Stay in Wintergreen.
Typically, the next step is an interview where questions are answered, any formalities are covered, and what HSW does and does not do is discussed.
After that, there is the payment of dues, either by check or credit card.
Again, THANK YOU for your application. If you have any questions, please email membership@HereToStayWTG.org.
