Let’s work together Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Why are you interested in joining the cooperative? * What do you hope to contribute to the cooperative? * What do you hope to receive from the cooperative? * How do you define mental & emotional health and wellbeing? * What skills do you hope to offer through the cooperative? * I'm interested in: Please check what interests you. One on one support Training & education for individuals Direct Services Consultation for promoting mental & emotional wellbeing Development of training curriculum Other (please specify below) (other) Membership Options * Please put a check mark by which option you choose. Full Equity Member: Pay $1,000 membership fee Not a full equity member until paid in full: Pay $100.00/month for 10 months Work-in: Pay $100.00 minimum paid in full, with remaining hours worked to equal $1,000.00. (One hour worked is equal to $50.00). One time membership fee. (Not a full equity member until paid in full with worked hours and payment.) Your Membership Commitment: * Please state the amount you'd like to pay and/or the number of hours you will work over the course of 10 months. For Example: Pay Minimum of $100.00, and work 19 hour over 10 months, equals $1,000.00. Signature * By entering your name here, you acknowledge your electronic signature. Date MM DD YYYY Thank you! Someone from the Ebb & Flow Cooperative will contact you soon! In the meantime, you can check out our resource and/or training pages.
