MMV Member Application
Our mission is to enable Mount Mansfield Villages (MMV) members to remain active, socially-connected, and independent in their homes and communities for as long as possible. Residents of the towns of Cambridge, Underhill, and Jericho who are over the age of 50 may join the MMV community as individual or family members for an annual fee.

Members have access to all of the MMV volunteer services such as local transportation, light repairs, and technical assistance. (For a list, see tiny.cc/mmvserv on the web.) Members can also hire skilled tradespeople and businesses that offer services such as snow plowing, yard maintenance, housekeeping, plumbing, etc. from a list of recommended providers.

A Sponsorship option is available for those who do not need services now but would like to attend educational and social events and to financially support the MMV community. (See tiny.cc/mmvspon on the web to submit a Sponsor application.)

Annual membership fees are $240 for an individual and $300 for a couple. However, no one will be excluded from joining due to financial need.

You may want to scan the form before you begin to be sure you have all the information you'll need.

IMPORTANT NOTE: If a question has a red asterisk at the end, it is "required"--i.e., it cannot be left blank. If you don't have an answer for a required question, enter "N/A" or something similar. Otherwise, you will not be able to submit the form.

IMPORTANT NOTE: There is no time limit on this form, but you must finish the form in one sitting--you cannot start the form today and come back to finish it tomorrow. Also, because the form is web-based, you'll want to complete it when you have a RELIABLE Internet connection so that you don't risk losing your work.

Time-saving Tip: Tap the <TAB> key to move to the next question.

Finally, if you'd rather fill out a paper form than this online form, please click tiny.cc/mmvmemp and then print, complete, and mail the form.

Your email *
If you don't have an email, please enter "No Email."
Your answer
Your first name *
Your answer
Your middle initial
Your answer
Your last name *
Your answer
Your preferred name (if it's different)
Your answer
Your date of birth (Optional)
MM
/
DD
/
YYYY
Your home phone (enter N/A if you don't have a landline) *
Your answer
Your cell phone (if you have one)
Your answer
Which phone do you prefer we call? *
Your street address *
Your answer
Your town *
Your zip code *
Your answer
Your mailing address (if it's different)
Your answer
Would you like to include your name and phone number in the Members Directory? Note: Only Members and MMV Staff can see this information. *
First Emergency Contact:
Name of first emergency contact *
Your answer
Landline (or N/A if no Landline) *
Your answer
Cell (if any)
Your answer
Email *
If the contact does not have an email, please enter "No Email."
Your answer
Relationship to Member *
Your answer
Second Emergency Contact
Name of second emergency contact
Your answer
Landline (or N/A if no Landline)
Your answer
Cell (if any)
Your answer
Email
If the contact does not have an email, please enter "No Email."
Your answer
Relationship to Member
Your answer
Type of Membership
Type of Membership *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service