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Rated: E · Survey Form · Other · #2225623
form to request help from GHA
one of two GHA logos for our group

Hello, if you or someone you know needs help to keep your existing WDC membership OR you have discovered you have outgrown your current membership and need help to upgrade, please fill out this form.

We will offer assistance as funds are available. There may be a waitlist, so your patience and understanding are appreciated. Please know we will help you just as soon as funds become available.
(R) denotes a required field.
1.   What is your WDC user name for contact purposes? Golden Heart Alliance will not share your information outside the group. (R)
     
2.   Choose which type of assistance you need. (R)
        Keeping an existing membership
        Upgrading an existing membership
3.   Do you need partial assistance or full assistance with the cost of the membership? (R)
        I need partial assistance
        I need full assistance
        I don't know
4.   Is your current membership in danger of expiring within the next 30 days? (R)
        Yes
        No
5.   IF you are asking for assistance to Upgrade your account to a higher membership, please tell why you feel you need to upgrade. (R)
     
6.   When does your current membership expire? (R)
     
*Note* Disclaimer: The information submitted will be sent to Tina Stone . Do not submit anything private or confidential.

               

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