REM Membership Form

Step 1. Choose your level of participation.

Please select all levels of participation that are appropriate for you and click "Total" to compute your total dues and donations.

The lower levels of participation are incremental and, if you also participate at one of the higher levels, we will waive the basic dues. Click to find out how this works.

Click on any level of participation to see a description of that level or, or click here to see the entire chart.

 Step 2. Pick a username & password.

REM members are responsible for keeping their contact information current. Your username and password will enable you login to our site and update your mailing address, e-mail addresses, and phone numbers as needed. Please note that passwords are case sensitive; usernames are not.
 *Username:
 *Password:

Please go to Step 3.
 Step 3. Set up your account.

Please complete all fields that apply. Fields marked with a red asterisk (*) are required. Please click on any field names in bold teal type for more infor­ma­tion. All information you give to REM stays within REM. We do not share our database with anybody, even the REM Partners.
 *First Name:
 *Last Name:
  Nickname:
 *Home Address:
  Line 2 of Address:
 *City:
 *State:
 *Zip Code:
  Home Phone:

Unlisted Number?

 No Yes
  Work Phone:
  FAX:
  Cell/Mobile Number:
 *E-mail Address:
  Alternate E-mail:

*Main Contact Person?:

 Yes No

Other REM Members in Your Home:
 Step 4. Tell us about your business.

If you are joining at the Sponsor, Con­sor­tium, or Partner levels on behalf of a business or nonprofit organization, please click the appropriate link below and tell us a little about the business or organization. Otherwise, you are ready to submit this form.

  • To submit this form, click "Join REM!"
  • To start over, click "Clear Form."
  • To leave this page without joining REM,
    click "REMnet Home."