Name *

First Name

Last Name

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Gender

Male

Female

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Spouse (if any) *

First Name

Last Name

Please indicate form of payment *

$18 monthly recurring (email us if you wish to discontinue membership)

$200 annual (we will remind you when its time for renewal)

Date of Payment *

MM

DD

YYYY

I am a:

New Member

Renewal Member

Tick to indicate consent *

I accept that membership into Willing Hearts Kindness Club are limited to persons to good moral character and reputation. I recognize the importance of rendering personal service to my community in cooperation with other civic-minded persons. I understand that membership is not valid until approved by the Willing Hearts' board of community

I understand the terms of membership application

Data Consent *

By submitting this form, I hereby agree and consent to Willing Hearts Kindness Club collecting, using, disclosing, and sharing my personal data for the purpose of membership processing and communications related to the Club's activities. I understand that my data will be handled in compliance with relevant privacy laws.

I agree to the data consent terms