Membership Information Request

Ready to Join?

Interested in exploring the possibility of membership in North Animas Village? We’re here to assist. Please complete the following questionnaire and a North Animas Village representative will contact you. If you're ready to join, click here for a printable application form and mail it to the address provided.

If you have questions or would like to speak with someone, call 970-759-7283 or email us at [email protected].

First name

Last name

Phone

Cell phone

Date of birth

Marital status

Gender

Number

Street

City

State

Zip Code

Available Membership Options

Monthly Payment Option: $11.00 per month for 12 months

Waiver/Scholarship: $0.00 for 12 months

Social Membership - cash or check: $75.00 for 12 months

Social Membership - credit card: $80.00 for 12 months

Full Membership - cash or check: $120.00 for 12 months

Full Membership - credit card: $125.00 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

First pet species

First pet breed

First pet name

First pet date of birth

Second pet species

Second pet breed

Second pet name

Second pet date of birth

Current Health

Mobility issues

Special needs

Home type

Home ownership

Employment status

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!