Membership Inquiry

Thank you for your interest in becoming a member of Wicomico at Home. Please complete the membership interest form or download this document and return to MAC, Inc. Our goal is to help connect, inspire and support neighbors who are 50+ in our community in living active and exciting lives! Services available to members include: social gatherings, transportation assistance, light home repairs, and friendly visits and calls. If you are the 50 or older, live in Wicomico County and meet basic ADL (Activities of Daily Living) requirements, please review the information below and submit your details so we may contact you for a membership application meeting.

Who are we? MAC has proudly served older adults on the Lower Shore since 1972. Wicomico at Home is designed for older adults to age in place, remaining safely in their homes with support of neighbors helping neighbors within Wicomico County, Maryland.

Who are the Wicomico at Home Members? Members are older adults who choose to live independently in their community. They are assisted by volunteers to do things they may need help with, to take them to appointments and shopping, to visit and call.

Who is eligible to become a member? Older adults who reside in Wicomico County and able to walk under their own power or with the assistance of a cane or walker are eligible and are cognitively intact.

LEVELS OF MEMBERSHIP

Full Membership: Eligible for all Wicomico at Home services and programs ($500 per individual per year OR $750 per household per year)

Supporting Memberships: Includes only access to all programs ($250 / individual or couple $200 of the $250 may be considered a charitable contribution)

Temporary membership: Call to discuss your short-term needs. $75 per month (maximum of 3 months.)

First name

Last name

Most Village correspondence is sent via email:

I use email (this is a good way to notify me)

I do not use email (if you email me information, I will likely not see it)

Phone

Cell phone

Date of birth

Gender

Number

Street

City

State

Zip Code

Available Membership Options

First emergency contact name

First emergency contact cell phone

First emergency contact phone

First emergency contact email

First emergency contact address

First emergency contact relationship

Second emergency contact name

Second emergency contact cell phone

Second emergency contact phone

Second emergency contact email

Second emergency contact address

Second emergency contact relationship

Current Health

Mobility issues

Special needs

Home type

Home ownership

Your interests what do you love doing

How did you hear about us

Additional Comments

I confirm that I have read, consent and agree to Revolutionaging’s (Helpful Village’s) TERMS OF USE and PRIVACY POLICY

Thank you for your interest

Thank you for contacting us — it’s a pleasure to connect! Our team is committed to providing friendly, professional assistance, and we’ll be reviewing your message right away. You’ll hear back from us soon.