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Heartful Rootz Membership Profile + Newsletter 
This is more than a profile — it is part of building community together. What you share helps us better understand your needs, your gifts, your hopes, and the kind of wellness space that would truly support you and your family. Together, we are shaping a space rooted in belonging, and we are grateful to grow this work in a spirit of care, reciprocity, belonging, and shared healing.  


Once you complete this profile, please circle back to our Support page and select the contribution amount that feels right for you, whether monthly or custom. 
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Email *
Name *
How do you identify?
Share any identities, communities, or descriptions that feel true to you.
*
Preffered Medium to communicate with  *
Required
Membership type *
Required
Your Monthly Contribution Amount  *
Would it be ok if we share your name as a suppporting member on our website?  *
Phone Number *
Mailing Address *
Birthday
Socail media handles *
Heritage *
Support you want, how can this space hold you best? What would help you feel most welcomed?  *
What is inspiring you to become a contributing member? *
Newsletter- Subscribing to: 
*
Required
Holistic Care needs *
Required
Items you like , list your favorites *
Required
Spiritual and Community Interests *
Skills you want to share in support
Would you like us to send you a welcome info kit you can share with friends, family, coworkers or community to invite them to become members?  *
Required
How did you hear about us? *
We’d love to get to know you more. Use this space to share anything about your family, your desires, your hopes, and what you want a community wellness space to really include. You can also tell us what would help you feel welcomed, supported, and cared for in community.   *
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