Love Club Membership Application
Welcome to Hipline! This quick form will help Hipline to determine who qualifies for a Love Club Pass Membership. Love Club Membership qualifies a Hipliner to purchase classes at the rate of $8 per class for one year.  Love Club Membership is designed to provide affordable Hipline classes to a small group of those who are experiencing persistent financial hardship.  Determination for inclusion is based on financial information and personal circumstances, with the California State poverty level used as a benchmark for suitability.
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What is your name? *
What is your email address? *
What is your phone number? *
How many dependents do you support? *
What was your adjusted gross income for last year? *
Please tell us a little bit about your financial circumstances that would help us understand your situation: *
How did you hear about Hipline? *
How often do you think you would attend classes at Hipline with the $8 per class rate? *
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