Individual Membership Application

Individual Membership Application
Indiv ID
Membership Type
Membership Option
Membership Option:
1 Period-${membershipOption}
Name of Main Point of Contact

First NameLast Name
Preferred Phone # for Main Point of Contact - Business
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Email for Main Point of Contact - Business
Please enter a valid Email
Title
Why do you want to become a member of Housing&? Check all that apply.

Other
How did you hear about Housing&?
Would you like to make a donation to Housing& in addition to your membership dues? ($)

Total Donation and Price
Stripe Fee
Salesforce Data
NOTE : If you are a Housing& member who works for a Nonprofit, For Profit or Government Agency, your organization’s membership benefits extend to all of your staff members. To ensure everyone in your office is kept abreast of Housing& communications and activities, please email the HAND team at info@housingand.org to ensure all team members are represented on your organization's profile
Please review the following information and check the box to indicate that you understand Housing&s membership billing.
Please review the following information and check the box to indicate that you understand the process of cancelling membership
Should be Empty: