MACH Membership Application: Individual

Member Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Primary Phone Number*

Please enter a valid phone number.

Secondary Phone Number (if applicable)

Please enter a valid phone number.

Email*

example@example.com

What is your interest in problems related to homelessness?

Membership Payment and Optional Donations*

Membership

$10 Individual Membership

Annual membership is valid from October 1 – September 30. For NEW MEMBERS ONLY, memberships purchased after June 30 will be valid until September 30 of the following year.

$10.00

Make a Donation to Support Our Work

$10 purchases a hygiene kit for someone living on the streets or in a place not meant for human habitation.

$10.00

$25 purchases a State I.D. for someone experiencing homelessness to access needed services.

$25.00

$50 purchases a one-month bus pass for someone experiencing homelessness to attend job training, look for employment, or report to work.

$50.00

$100 supports daily activities of our Street Outreach and Housing programs.

$100.00

$500 supports our work to assess needs, secure resources, and implement plans to end homelessness in our area.

$500.00

Donate Another Amount

$1.00 Donation Amount
Item subtotal:$0.00

Total

$0.00

Individual Membership Application