Thrive Membership Renewal Form
Name
*
First Name
Last Name
Email
*
example@example.com
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Has any of your contact information changed since last year?
*
Yes
No
If yes, please update the following.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Emergency Information
Name
First Name
Last Name
Relationship
Contact's Phone Number
Please enter a valid phone number.
Contact's Email
example@example.com
Please list any medical conditions or special accommodations emergency personnel should be aware of:
Additional Information
What are your skills and interest?
Are you currently involved in any local clubs or civic groups?
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Demographic information
Please complete the following information. This information helps to keep our records up to date and assists us when applying for grants.
Gender
*
Please Select
Male
Female
Non-Binary
Prefer not to answer
Marital Status
*
Please Select
Married
Partnership
Single
Widowed
Divorced
Are you a Veteran?
*
Please Select
Yes
No
Prefer not to answer
Is/Was your spouse, parent or child a Veteran?
*
Please Select
Yes
No
Prefer not to answer
Education/Degree Level:
Please Select
High School/GED
College
Graduate
Doctorate
Prefer not to answer
Language
*
Please Select
English
Other
Prefer not to answer
If other, please specify
Ethnicity
*
Please Select
Asian
American Indian or Alaskan Native
Black/African American
Hispanic/Latino/Spanish
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White/Caucasian
Other
Prefer not to answer
If other, please specify
Household type
*
Please Select
Single home
Townhome/Duplex
Apartment
Prefer not to answer
I have a household size of:
*
One
Two or more
My income for a household of 1 is:
At or below $18,825 ($1,569/month)
Between $18,826 - $ 37,650 ($1,570 - $3,138/month)
At or above $37,651 ($3,139/month)
Prefer not to answer
My income for a household of 2 or more is:
At or below $25,550 ($2,129/month)
Between $25,551 - $51,100 ($2,130 - $4,258/month)
At or above $51,101 ($4,259/month)
Prefer not to answer
Thank you for completing your Thrive membership renewal form.
Please call (651)439-7434 and ask to speak with a member of the Thrive team if you have any questions.
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