Membership Form

Thank You For Your Interest!

Thank you for your interest in becoming a member of the Independence Club. It is through people like you that the Club’s doors remain open and offers a refuge for those seeking recovery. Pay it forward! Become an Independence Club Member today!

Please download the form below, fill it out and give to any Independence Club Member, drop it in the safe in the office or mail it to: The Independence Club, Attn: Memberships, 7043 Wimsatt Road, Springfield, VA 22151. Please be sure to include a check for an annual, six month or lifetime membership amount.

Your club membership is Tax Deductible and you will receive a Tax Deductible receipt for your taxes.

Membership_Form
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