Membership Application

Membership is extra rewarding in 2012 while we offer discounted PODS to the first new 100 members this year!  Connected-at-Home membership is the first step toward simplifying your life so do submit this form promptly.  You may call during business hours for details.

Please complete the form below or click here to download and print our Membership Application.

Membership Application

(*) Indicates a required field





Your Name*

By what name shall we call you?

Gender*
MaleFemale

Date of Birth*

Street Address*

Home Telephone*

Other phone numbers to reach you

Housemates (spouse, sibling, friend…)

Emergency Contact* (and relationship to you)

Pets and animals

PODS of interest to you:*
CalendarDocument InventoryHealthcare InformationHousehold Bill PayingHousehold Support

Your Email*

Your membership begins the month that you sign this agreement; it will automatically renew annually, unless you inform us otherwise. Connected-at-Home reserves the right to be in touch with my contacts in case of situation of health or safety concerns.

I understand that annual membership in Connected-at-Home costs $360 and is non-refundable after thirty days. I hereby release and discharge Connected-at-Home from all responsibility or liability for services rendered by any third-party providers.