Vibrant Membership Application

Thank you for your interest in becoming a Vibrant Member!

Not quite ready? Join us for a complimentary class! Sign up through our event calendar.

Members receive unlimited access to our programming, plus a welcome gift bag, Vibrant shirt, and more—a $40 value!

Membership Reminders:
- Applicants should live in West Orange County, FL.
- Applicants should be at least 55 years old. For Household Memberships, only the primary member must meet this age requirement.
- Applicants should be independently mobile, unless they will always be accompanied by a caregiver or attendant.

Your Information

First name

Last name

Phone

Cell phone

I agree to receive SMS/text messages from Creative Aging, LLC dba Vibrant about events, volunteer opportunities and service updates

Message frequency varies. Message & data rates may apply. Reply STOP to unsubscribe. Reply HELP for help. Privacy Policy and Terms of Use

Date of birth

Marital status

Gender

Local village

Race

Ethnicity

Address

Number

Street

City

State

Zip Code

Available Membership Options

Vibrant Membership - Household: $300.00 for 12 months ($25.00/mo if paid monthly) Vibrant Membership- Individual: $225.00 for 12 months ($18.75/mo if paid monthly)

Additional Information

First Emergency Contact

First emergency contact name

First emergency contact relationship

First emergency contact cell phone

First emergency contact phone

First emergency contact email

First emergency contact address

Second Emergency Contact

Second emergency contact name

Second emergency contact relationship

Second emergency contact cell phone

Second emergency contact phone

Second emergency contact email

Second emergency contact address

Your interests what do you love doing

How did you hear about us

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 contacting us — it’s a pleasure to connect! Our team is committed to providing friendly, professional assistance, and we’ll be reviewing your message right away. You’ll hear back from us soon.