Become an Individual Member

NOTE! You will be able to review your information and make changes at the end of this process. Do not press the "back" button or you could lose the information you've entered up until now.

If you are a current user, please log in before starting the enrollment process.

My Membership Enrollment

* Required Field

Company Name

Prefix

*First Name

Middle Name

*Last Name

Suffix

*Date of Birth

/ / (MM/DD/YYYY)

Title

*Email

Secondary Email

Preferred Phone

Primary Phone Secondary Phone Mobile Phone

* Primary Phone

Ext. No dashes or spaces

* Secondary Phone

Ext. No dashes or spaces

* Mobile Phone

No dashes or spaces

Mailing Address

Primary Address Secondary Address

Primary Address

* Address

Address 2

* City

* State

* Country

* Zip Code

Secondary Address

* Address

Address 2

* City

* State

* Country

* Zip Code

*Let me know about upcoming volunteer opportunities.

Dietary Restrictions

Food Allergies

*Emergency Contact Name

*Emergency Contact Phone

*Use of Name and Image

BARN may from time to time create photographic or video records of activities to be used to publicize BARN’s activities and services. I consent to use by BARN of my image, voice, name, and story, and of images of any works I may create in BARN’s digital and print promotional, fundraising, educational, and other communications (i.e. social media).

If completing this form for a child for whom I am a parent/guardian ("my child"), I consent to BARN's use of my child's image, voice, name, and story, and of images of any works they may create in BARN’s digital and print promotional, fundraising, educational, and other communications (i.e. social media).

*Terms & Conditions

I agree

By checking this box, I agree to BARN's Code of Conduct and Hold Harmless Waiver