Founding Member Sign-Up (Step 1)Welcome! Before accessing the Founding Member area, please complete this short form so we can assign your region and keep you updated. Name * First Name Last Name Email * City * State * List My Name, Email, City & State (Location) in the Member Only Directory * Your listing is ONLY available to paid members and cannot be used for solicitation in any way. Yes, List Me! No, Not At This Time! Membership Type: * Community Member (Free) Founding Member Regional Leader Do You Identify As A Solo Ager? (Older Adult 55+ Without the Reliable Support of Adult Children/Family Members) * Yes No Age Range * 50 - 59 60 - 69 70 - 79 80 - 89 90 + Region * Region 1: New England (CT, ME, MA, NH, RI, VT) Region 2: Middle Atlantic (NJ, NY, PA) Region 3: East North Central (IL, IN, MI, OH, WI) Region 4: West North Central (IA, KS, MN, MO, NE, ND, SD) Region 5: South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV) Region 6: East South Central (AL, KY, MS, TN) Region 7: West South Central (AR, LA, OK, TX) Region 8: Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) Region 9: Pacific (AK, CA, HI, OR, WA) Interest Level: * Participant Interested in Leadership Thank you!
