Membership Application

Main Street Connect Activity Memberships

PLUS Membership	CORE Membership
$99 per month per person	$30 per month for the first household family member and $15 per month for each additional household family member
Most program and event fees included	Additional program and event fees ($5-$15 each)

Activity Membership Application

Select your ACTIVITY Membership type:

PLUS Monthly Membership

CORE Monthly Membership

Professional Membership (Individual)

Professional Membership (2-5 Employees)

Professional Membership (6-10 Employees)

Professional Membership (11+ Employees)

PLUS Membership Annual

CORE Annual Membership

Featured Events Membership

Your membership fees will automatically process each month.

How did you hear about Main Street? If you selected "Other" please share: What types of programming are you most interested in? (Select all that apply)

Wellness (ex: yoga, boxing, Zumba)

Cultural/Educational (ex: museum tours, baking, music)

Social (ex: game days, Main Street Hang, clubs)

Personal Development (ex: social skills, social action, philanthropy)

Other (Please share below)

If you selected "Other" please share:

Contact Information

First Name: Last Name: Email: Phone 1: Phone Type: Phone 2: Phone Type: I want to get text alerts from Main Street for event reminders, weather delays, closures and cancellations.

Yes (Please be sure you provide a mobile phone number)

Home Address: City: State: Zip: -

Main Street prides itself on being a fully inclusive community. We ask the following questions to ensure that we are staying true to our values, and to meet the requirements of some of our funders.

Birth Date: / / Pronouns: Are you of Hispanic, Latino, or Spanish origin? (select all that apply)

Not of Hispanic, Latino, or Spanish origin

Mexican, Mexican Am., Chicano

Puerto Rican

Cuban

Another Hispanic, Latino, or Spanish origin (for example, Salvadoran, Dominican, Colombian, Guatemalan, Spaniard, Ecuadorian, etc.)

Prefer not to answer

What is your race? (select all that apply) Do you identify as having a disability?

Yes

At times, will you be bringing a support person with you to events?

Yes

Emergency Contact Information

Emergency Contact Name: Relationship of Emergency Contact to Client: Emergency Contact Email: Emergency Contact Phone Number:

Click here to read Main Street's Membership Terms & Conditions
A full copy of the Membership Handbook will be available once your application is processed.