Online Membership ApplicationToday's Date* MM slash DD slash YYYY Primary MemberName* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Gender*Primary Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Secondary Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary Phone*Secondary PhoneEmail* I have been fully Covid-19 vaccinated Yes NoOther Household MembersSecond Member Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last GenderThird Member Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last GenderMembership FeeIndividual Membership:$300 if paid annually, $375 if paid quarterly ($93.75 per quarter)Household Membership (2-3 people): $400 if paid annually, $500 if paid quarterly ($125 per quarter)Type of MembershipIndividualHousehold (2-3)How did you hear about Neighbors Network?ΔA Neighbors Network representative will follow up with you soon to answer your questions and complete the application process.Questions? E-mail Patty@NeighborsNetworkFL.org or Call (321) 209-2775