Village Drive Village Silver Membership Application
Village Drive Village (VDV) is a non-profit, tax exempt, 501(c)(3) organization which offers
non-medical help to retired people in the neighborhoods surrounding Brentwood Park of Fairfax.
Our objective is to provide a range of reliable services enabling members to remain independent,
in their own homes, enjoying their favorite activities and continuing to be involved in our neighborhood.
We welcome all; we do not discriminate on the basis of race, color, religion, gender,
gender expression, national origin, or sexual orientation.

BENEFITS
Helpline for information and to schedule handyman, technology help (computers, alarms, tv), errands, organization, special activities, and other services, including temporary assistance with housework or pets
Home visit assessment
Optional check-in or courtesy calls and visits
Access to newsletters, membership directory, recommended service providers, calendar of events
Invitations to social events (additional fees for some events like lunch out and trips)

What is your first name? *
Your answer
What is your last name? *
Your answer
What is your age? *
Your answer
Is there another member of your household who will also be a member? *
First name of 2nd member of household
Your answer
Last name of 2nd member of household
Your answer
Please enter your home address below. *
Your answer
If you have a home phone number, please enter it below.
Your answer
Enter your email address below.
Your answer
If you have a cell phone number, please enter it below.
Your answer
If the 2nd member of your house has a separate email address, please enter it here:
Your answer
If the 2nd member of your house has a separate phone number, please enter it here:
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Village Drive Village. Report Abuse - Terms of Service