{"id":37169,"date":"2025-08-11T13:56:47","date_gmt":"2025-08-11T17:56:47","guid":{"rendered":"https:\/\/www.elderplan.org\/?page_id=37169"},"modified":"2025-10-09T18:16:24","modified_gmt":"2025-10-09T22:16:24","slug":"member-to-member-application","status":"publish","type":"page","link":"https:\/\/www.elderplan.org\/es\/member-benefits\/member-to-member-community\/member-to-member-application\/","title":{"rendered":"Member to Member"},"content":{"rendered":"\n<div class=\"wp-block-columns padding-interior is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\" id=\"form\">\n<p>Complete la solicitud en l\u00ednea de forma segura y siguiendo unos simples pasos. Comience con su n.\u00b0 de identificaci\u00f3n de miembro de Elderplan o HomeFirst. Es el n\u00famero que <strong>aparece junto al n.\u00b0 de identificaci\u00f3n de miembro en su tarjeta de beneficios de Elderplan<\/strong>. Luego le haremos preguntas sobre usted y sus intereses.<\/p>\n\n\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f37171-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"37171\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/es\/wp-json\/wp\/v2\/pages\/37169#wpcf7-f37171-o1\" method=\"post\" class=\"wpcf7-form init cf7mls-no-scroll cf7mls-auto-return-first-step cf7mls-no-moving-animation\" id=\"member-to-member-form\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"37171\"><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\"><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\"><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f37171-o1\"><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\"><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\"><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\"><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\"><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\"><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\"><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\"><input type=\"hidden\" name=\"_wpcf7cf_options\" value='{\"form_id\":37171,\"conditions\":[{\"then_field\":\"group-contact-method-email\",\"and_rules\":[{\"if_field\":\"contact-method\",\"operator\":\"equals\",\"if_value\":\"Email\"}]},{\"then_field\":\"group-contact-method-cell-phone\",\"and_rules\":[{\"if_field\":\"contact-method\",\"operator\":\"equals\",\"if_value\":\"Cell Phone\"}]},{\"then_field\":\"group-contact-method-landline\",\"and_rules\":[{\"if_field\":\"contact-method\",\"operator\":\"equals\",\"if_value\":\"Landline Phone\"}]},{\"then_field\":\"group-preferred-call-time\",\"and_rules\":[{\"if_field\":\"contact-method\",\"operator\":\"equals\",\"if_value\":\"Cell Phone\"}]},{\"then_field\":\"group-preferred-call-time\",\"and_rules\":[{\"if_field\":\"contact-method\",\"operator\":\"equals\",\"if_value\":\"Landline Phone\"}]},{\"then_field\":\"group-text-message-opt-in\",\"and_rules\":[{\"if_field\":\"contact-method\",\"operator\":\"equals\",\"if_value\":\"Cell Phone\"}]},{\"then_field\":\"group-other-accomodation\",\"and_rules\":[{\"if_field\":\"special-considerations\",\"operator\":\"equals\",\"if_value\":\"Other\"}]},{\"then_field\":\"group-device-other\",\"and_rules\":[{\"if_field\":\"device-used\",\"operator\":\"equals\",\"if_value\":\"Other\"}]},{\"then_field\":\"group-hobbies-other\",\"and_rules\":[{\"if_field\":\"hobbies-other-radio\",\"operator\":\"equals\",\"if_value\":\"Other\"}]},{\"then_field\":\"group-pet-types-other\",\"and_rules\":[{\"if_field\":\"pet-types-other-radio\",\"operator\":\"equals\",\"if_value\":\"Other\"}]},{\"then_field\":\"group-music-types-other\",\"and_rules\":[{\"if_field\":\"music-types-other-radio\",\"operator\":\"equals\",\"if_value\":\"Other\"}]},{\"then_field\":\"group-work-status-other\",\"and_rules\":[{\"if_field\":\"work-status\",\"operator\":\"equals\",\"if_value\":\"Other\"}]},{\"then_field\":\"group-future-interests-other\",\"and_rules\":[{\"if_field\":\"radio-future-interests\",\"operator\":\"equals\",\"if_value\":\"Other\"}]},{\"then_field\":\"group-following-topics-other\",\"and_rules\":[{\"if_field\":\"following-topics\",\"operator\":\"equals\",\"if_value\":\"Other\"}]},{\"then_field\":\"group-how-did-you-hear-other\",\"and_rules\":[{\"if_field\":\"how-did-you-hear\",\"operator\":\"equals\",\"if_value\":\"Other\"}]},{\"then_field\":\"group-name-care-manager\",\"and_rules\":[{\"if_field\":\"how-did-you-hear\",\"operator\":\"equals\",\"if_value\":\"Care Manager referral\"}]},{\"then_field\":\"group-friendly-chats\",\"and_rules\":[{\"if_field\":\"cf7mls_step-2\",\"operator\":\"equals\",\"if_value\":\"true\"},{\"if_field\":\"virtual-services\",\"operator\":\"equals\",\"if_value\":\"Friendly chats\"}]},{\"then_field\":\"group-virtual-assistance\",\"and_rules\":[{\"if_field\":\"virtual-services\",\"operator\":\"not empty\",\"if_value\":\"\"}]},{\"then_field\":\"group-pets-and-music\",\"and_rules\":[{\"if_field\":\"virtual-services\",\"operator\":\"not equals\",\"if_value\":\"Friendly chats\"}]}],\"settings\":{\"animation\":\"yes\",\"animation_intime\":200,\"animation_outtime\":200,\"conditions_ui\":\"normal\",\"notice_dismissed\":false,\"notice_dismissed_update-cf7-5.9.8\":true,\"notice_dismissed_update-cf7-6.0\":true,\"notice_dismissed_update-cf7-6.0.1\":true,\"notice_dismissed_update-cf7-6.0.2\":true,\"notice_dismissed_update-cf7-6.0.3\":true,\"notice_dismissed_update-cf7-6.0.6\":true,\"notice_dismissed_update-cf7-6.1.1\":true,\"notice_dismissed_update-cf7-6.1.4\":true,\"notice_dismissed_update-cf7-6.1.5\":true}}'><input type=\"hidden\" name=\"_wpcf7dtx_version\" value=\"5.0.5\"><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\">\n<\/fieldset>\n<div class=\"fieldset-cf7mls-wrapper\" data-transition-effects><fieldset class=\"fieldset-cf7mls cf7mls_current_fs\"><div class=\"m2m-join\">\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"elderplan-member-id\">\n\t<div class=\"screen-reader-response\">\n\t\t<div role=\"status\" aria-live=\"polite\">\n\t\t<\/div>\n\t<\/div>\n\t<h2>Contact Information\n\t<\/h2>\n\t<p>Thank you for your interest in Elderplan's Member to Member Program, we are excited to have you join us!\n\t<\/p>\n\t<p>To help us better understand your needs, please provide the following demographic information.<br>\nYour responses will be kept confidential.\n\t<\/p>\n\t<div class=\"bounding-box\">\n\t\t<h3> How should we contact you?\n\t\t<\/h3>\n\t\t<p class=\"fine-text\">Please select how best we can communicate with you.\n\t\t<\/p>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"contact-method\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"contact-method\" value=\"Email\"><span class=\"wpcf7-list-item-label\">Email<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"contact-method\" value=\"Cell Phone\"><span class=\"wpcf7-list-item-label\">Cell Phone<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"contact-method\" value=\"Landline Phone\"><span class=\"wpcf7-list-item-label\">Landline Phone<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div data-id=\"group-contact-method-email\" data-orig_data_id=\"group-contact-method-email\" data-clear_on_hide class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<p><label for=\"member-email\" class=\"label-bold\">Email Address<\/label>\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"member-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" placeholder=\"Email\" value=\"\" type=\"email\" name=\"member-email\"><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div data-id=\"group-contact-method-cell-phone\" data-orig_data_id=\"group-contact-method-cell-phone\" data-clear_on_hide class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<p><label for=\"member-cell-phone\" class=\"label-bold\">Cell Phone Number<\/label>\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"member-cell-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" placeholder=\"Cell Phone\" value=\"\" type=\"tel\" name=\"member-cell-phone\"><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div data-id=\"group-contact-method-landline\" data-orig_data_id=\"group-contact-method-landline\" data-clear_on_hide class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<p><label for=\"member-landline-phone\" class=\"label-bold\">Landline Phone Number<\/label>\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"member-landline-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" placeholder=\"Landline Phone\" value=\"\" type=\"tel\" name=\"member-landline-phone\"><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div data-id=\"group-preferred-call-time\" data-orig_data_id=\"group-preferred-call-time\" class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<h4>What is your preferred time to receive calls?\n\t\t\t<\/h4>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"preferred-time\"><span class=\"wpcf7-form-control wpcf7-radio radio-hide-default\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"preferred-time\" value=\"Default\" checked><span class=\"wpcf7-list-item-label\">Default<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"preferred-time\" value=\"Morning\"><span class=\"wpcf7-list-item-label\">Morning<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"preferred-time\" value=\"Afternoon\"><span class=\"wpcf7-list-item-label\">Afternoon<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"preferred-time\" value=\"Evening\"><span class=\"wpcf7-list-item-label\">Evening<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div data-id=\"group-text-message-opt-in\" data-orig_data_id=\"group-text-message-opt-in\" class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<h4>Would you like to receive text messages?\n\t\t\t<\/h4>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"text-message-opt-in\"><span class=\"wpcf7-form-control wpcf7-radio radio-hide-default\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"text-message-opt-in\" value=\"Default\" checked><span class=\"wpcf7-list-item-label\">Default<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"text-message-opt-in\" value=\"Yes\"><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"text-message-opt-in\" value=\"No\"><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-1\" style=\" \">Next Page<img decoding=\"async\" src=\"https:\/\/www.elderplan.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.elderplan.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\"><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n\n<div class=\"m2m-join\">\n\t<div class=\"screen-reader-response\">\n\t\t<div role=\"status\" aria-live=\"polite\">\n\t\t<\/div>\n\t<\/div>\n\t<h2>Activities and Events\n\t<\/h2>\n\t<div class=\"bounding-box\">\n\t\t<h4>Are there any special considerations we should know about you that will help us in developing our program?\n\t\t<\/h4>\n\t\t<p class=\"fine-text\">Select as many as you like\n\t\t<\/p>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"special-considerations\"><span class=\"wpcf7-form-control wpcf7-checkbox special-considerations\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"special-considerations[]\" value=\"I am visually impaired\"><span class=\"wpcf7-list-item-label\">I am visually impaired<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"special-considerations[]\" value=\"I am deaf, hard of hearing, or use TTY\"><span class=\"wpcf7-list-item-label\">I am deaf, hard of hearing, or use TTY<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"special-considerations[]\" value=\"I am a wheelchair user\"><span class=\"wpcf7-list-item-label\">I am a wheelchair user<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"special-considerations[]\" value=\"I am bedbound\"><span class=\"wpcf7-list-item-label\">I am bedbound<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"special-considerations[]\" value=\"Other\"><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div data-id=\"group-other-accomodation\" data-orig_data_id=\"group-other-accomodation\" data-clear_on_hide class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"other-accomodation-field\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"other-accomodation-field\"><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"accomodations-na\"><span class=\"wpcf7-form-control wpcf7-radio clear-special-considerations radio-hide-default\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"accomodations-na\" value=\"Default\" checked><span class=\"wpcf7-list-item-label\">Default<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"accomodations-na\" value=\"I do not need accomodations\"><span class=\"wpcf7-list-item-label\">I do not need accomodations<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"bounding-box\">\n\t\t<h4>We are currently offering the following <u>IN-PERSON<\/u> services and activities:\n\t\t<\/h4>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"activity-offerings\"><span class=\"wpcf7-form-control wpcf7-checkbox activity-offerings\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"activity-offerings[]\" value=\"Washington Heights (Manhattan) office events\"><span class=\"wpcf7-list-item-label\">Washington Heights (Manhattan) office events<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"activity-offerings-na\"><span class=\"wpcf7-form-control wpcf7-radio clear-activity-offerings radio-hide-default\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"activity-offerings-na\" value=\"Default\" checked><span class=\"wpcf7-list-item-label\">Default<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"activity-offerings-na\" value=\"I am not interested in in-person events at this time\"><span class=\"wpcf7-list-item-label\">I am not interested in in-person events at this time<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"bounding-box\">\n\t\t<h4>We are currently offering the following <u>VIRTUAL<\/u> events that you can join from the comfort of your home.\n\t\t<\/h4>\n\t\t<p class=\"fine-text\">Select as many as you like\n\t\t<\/p>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"virtual-services\"><span class=\"wpcf7-form-control wpcf7-checkbox virtual-services\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"virtual-services[]\" value=\"Chair yoga\"><span class=\"wpcf7-list-item-label\">Chair yoga<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"virtual-services[]\" value=\"Cooking classes\"><span class=\"wpcf7-list-item-label\">Cooking classes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"virtual-services[]\" value=\"Dance and exercise classes\"><span class=\"wpcf7-list-item-label\">Dance and exercise classes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"virtual-services[]\" value=\"Friendly chats\"><span class=\"wpcf7-list-item-label\">Friendly chats<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"virtual-services[]\" value=\"Health education\"><span class=\"wpcf7-list-item-label\">Health education<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"virtual-services[]\" value=\"Meditation\"><span class=\"wpcf7-list-item-label\">Meditation<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"virtual-services[]\" value=\"Virtual concerts\"><span class=\"wpcf7-list-item-label\">Virtual concerts<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"virtual-services[]\" value=\"Virtual games\"><span class=\"wpcf7-list-item-label\">Virtual games<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"virtual-services-na\"><span class=\"wpcf7-form-control wpcf7-radio clear-virtual-services radio-hide-default\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"virtual-services-na\" value=\"Default\" checked><span class=\"wpcf7-list-item-label\">Default<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"virtual-services-na\" value=\"I am not interested in virtual events at this time\"><span class=\"wpcf7-list-item-label\">I am not interested in virtual events at this time<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div data-id=\"group-virtual-assistance\" data-orig_data_id=\"group-virtual-assistance\" class=\"\" data-class=\"wpcf7cf_group\">\n\t\t<div class=\"bounding-box\">\n\t\t\t<h4>Do you need any technical assistance from us with logging in to the event?\n\t\t\t<\/h4>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"technical-assistance\"><span class=\"wpcf7-form-control wpcf7-radio radio-hide-default\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"technical-assistance\" value=\"Default\" checked><span class=\"wpcf7-list-item-label\">Default<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"technical-assistance\" value=\"Yes\"><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"technical-assistance\" value=\"No\"><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"bounding-box\">\n\t\t\t<h4>What device will you use to join the virtual events?\n\t\t\t<\/h4>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"device-used\"><span class=\"wpcf7-form-control wpcf7-radio column-style radio-hide-default\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"device-used\" value=\"Default\" checked><span class=\"wpcf7-list-item-label\">Default<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"device-used\" value=\"iPhone with data plan\"><span class=\"wpcf7-list-item-label\">iPhone with data plan<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"device-used\" value=\"Android with data plan\"><span class=\"wpcf7-list-item-label\">Android with data plan<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"device-used\" value=\"Computer, laptop, or tablet that connects to the internet\"><span class=\"wpcf7-list-item-label\">Computer, laptop, or tablet that connects to the internet<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"device-used\" value=\"Landline phone\"><span class=\"wpcf7-list-item-label\">Landline phone<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"device-used\" value=\"Other\"><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t\t<div data-id=\"group-device-other\" data-orig_data_id=\"group-device-other\" data-clear_on_hide class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"other-device-field\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"other-device-field\"><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-2\" style=\" \">Previous Page<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-2\" style=\" \">Next Page<img decoding=\"async\" src=\"https:\/\/www.elderplan.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.elderplan.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\"><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n\n<div class=\"m2m-join\">\n\t<div class=\"screen-reader-response\">\n\t\t<div role=\"status\" aria-live=\"polite\">\n\t\t<\/div>\n\t<\/div>\n\t<div data-id=\"group-friendly-chats\" data-orig_data_id=\"group-friendly-chats\" class=\"\" data-class=\"wpcf7cf_group\">\n\t\t<h2>About You\n\t\t<\/h2>\n\t\t<p>Thank you for your interest in Friendly Chats! Answering these and other questions will help us find the best partner for your chat sessions\n\t\t<\/p>\n\t\t<div class=\"bounding-box\">\n\t\t\t<h3>Your Hobbies\n\t\t\t<\/h3>\n\t\t\t<div class=\"bounding-box\">\n\t\t\t\t<h4>What are your hobbies?\n\t\t\t\t<\/h4>\n\t\t\t\t<p class=\"fine-text\">Select as many as you like\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"hobbies\"><span class=\"wpcf7-form-control wpcf7-checkbox grid-3\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"hobbies[]\" value=\"Boardgames\"><span class=\"wpcf7-list-item-label\">Boardgames<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"hobbies[]\" value=\"Cooking\"><span class=\"wpcf7-list-item-label\">Cooking<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"hobbies[]\" value=\"Exercise\"><span class=\"wpcf7-list-item-label\">Exercise<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"hobbies[]\" value=\"Gardening\"><span class=\"wpcf7-list-item-label\">Gardening<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"hobbies[]\" value=\"Journaling\"><span class=\"wpcf7-list-item-label\">Journaling<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"hobbies[]\" value=\"Knitting\"><span class=\"wpcf7-list-item-label\">Knitting<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"hobbies[]\" value=\"Music\"><span class=\"wpcf7-list-item-label\">Music<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"hobbies[]\" value=\"Photography\"><span class=\"wpcf7-list-item-label\">Photography<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"hobbies[]\" value=\"Reading\"><span class=\"wpcf7-list-item-label\">Reading<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"hobbies[]\" value=\"Religious Activities\"><span class=\"wpcf7-list-item-label\">Religious Activities<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"hobbies[]\" value=\"Television\/News\"><span class=\"wpcf7-list-item-label\">Television\/News<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"hobbies[]\" value=\"Walking\"><span class=\"wpcf7-list-item-label\">Walking<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"hobbies-other-radio\"><span class=\"wpcf7-form-control wpcf7-radio radio-hide-default\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"hobbies-other-radio\" value=\"Default\" checked><span class=\"wpcf7-list-item-label\">Default<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"hobbies-other-radio\" value=\"Other\"><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div data-id=\"group-hobbies-other\" data-orig_data_id=\"group-hobbies-other\" class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"hobbies-other\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"hobbies-other\"><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div data-id=\"group-pets-and-music\" data-orig_data_id=\"group-pets-and-music\" class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t\t<div class=\"bounding-box\">\n\t\t\t\t\t<h4>What kind of pet(s) do you have?\n\t\t\t\t\t<\/h4>\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"pet-types-na-radio\"><span class=\"wpcf7-form-control wpcf7-radio clear-pet-types radio-hide-default\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"pet-types-na-radio\" value=\"Default\" checked><span class=\"wpcf7-list-item-label\">Default<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"pet-types-na-radio\" value=\"I don't have any pets\"><span class=\"wpcf7-list-item-label\">I don't have any pets<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"pet-types\"><span class=\"wpcf7-form-control wpcf7-checkbox grid-2 pet-types\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"pet-types[]\" value=\"Bird(s)\"><span class=\"wpcf7-list-item-label\">Bird(s)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"pet-types[]\" value=\"Cat(s)\"><span class=\"wpcf7-list-item-label\">Cat(s)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"pet-types[]\" value=\"Dog(s)\"><span class=\"wpcf7-list-item-label\">Dog(s)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"pet-types[]\" value=\"Fish\"><span class=\"wpcf7-list-item-label\">Fish<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"pet-types[]\" value=\"Lizard(s)\/Reptile(s)\"><span class=\"wpcf7-list-item-label\">Lizard(s)\/Reptile(s)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"pet-types[]\" value=\"Rabbit(s)\"><span class=\"wpcf7-list-item-label\">Rabbit(s)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"pet-types-other-radio\"><span class=\"wpcf7-form-control wpcf7-radio radio-hide-default\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"pet-types-other-radio\" value=\"Default\" checked><span class=\"wpcf7-list-item-label\">Default<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"pet-types-other-radio\" value=\"Other\"><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<div data-id=\"group-pet-types-other\" data-orig_data_id=\"group-pet-types-other\" class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"pet-types-other\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pet-types-other\"><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"bounding-box\">\n\t\t\t\t\t<h4>What kind of music do you listen to?\n\t\t\t\t\t<\/h4>\n\t\t\t\t\t<p class=\"fine-text\">Select as many as you like\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"music-types\"><span class=\"wpcf7-form-control wpcf7-checkbox grid-3\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"music-types[]\" value=\"Blues\"><span class=\"wpcf7-list-item-label\">Blues<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"music-types[]\" value=\"Classical\"><span class=\"wpcf7-list-item-label\">Classical<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"music-types[]\" value=\"Country\"><span class=\"wpcf7-list-item-label\">Country<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"music-types[]\" value=\"Dance\"><span class=\"wpcf7-list-item-label\">Dance<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"music-types[]\" value=\"Disco\"><span class=\"wpcf7-list-item-label\">Disco<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"music-types[]\" value=\"Jazz\"><span class=\"wpcf7-list-item-label\">Jazz<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"music-types[]\" value=\"Latin\"><span class=\"wpcf7-list-item-label\">Latin<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"music-types[]\" value=\"Motown\"><span class=\"wpcf7-list-item-label\">Motown<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"music-types[]\" value=\"Oldies\"><span class=\"wpcf7-list-item-label\">Oldies<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"music-types[]\" value=\"R&amp;B\"><span class=\"wpcf7-list-item-label\">R&amp;B<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"music-types[]\" value=\"Rock\"><span class=\"wpcf7-list-item-label\">Rock<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"music-types-other-radio\"><span class=\"wpcf7-form-control wpcf7-radio radio-hide-default\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"music-types-other-radio\" value=\"Default\" checked><span class=\"wpcf7-list-item-label\">Default<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"music-types-other-radio\" value=\"Other\"><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<div data-id=\"group-music-types-other\" data-orig_data_id=\"group-music-types-other\" class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"music-types-other\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"music-types-other\"><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"bounding-box\">\n\t\t\t<h3>Career and Work Status\n\t\t\t<\/h3>\n\t\t\t<div class=\"bounding-box\">\n\t\t\t\t<h4>What is your current work status?\n\t\t\t\t<\/h4>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"work-status\"><span class=\"wpcf7-form-control wpcf7-radio column-style radio-hide-default\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"work-status\" value=\"Default\" checked><span class=\"wpcf7-list-item-label\">Default<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"work-status\" value=\"Retired\"><span class=\"wpcf7-list-item-label\">Retired<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"work-status\" value=\"Employed\"><span class=\"wpcf7-list-item-label\">Employed<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"work-status\" value=\"Self-Employed\"><span class=\"wpcf7-list-item-label\">Self-Employed<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"work-status\" value=\"Other\"><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div data-id=\"group-work-status-other\" data-orig_data_id=\"group-work-status-other\" class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"work-status-other\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"work-status-other\"><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<h4>What industry were\/are you in?\n\t\t\t<\/h4>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"industry-type\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"industry-type\"><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-3\" style=\" \">Previous Page<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-3\" style=\" \">Next Page<img decoding=\"async\" src=\"https:\/\/www.elderplan.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.elderplan.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\"><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n\n<div class=\"m2m-join\">\n\t<div class=\"screen-reader-response\">\n\t\t<div role=\"status\" aria-live=\"polite\">\n\t\t<\/div>\n\t<\/div>\n\t<h2>Future Programming\n\t<\/h2>\n\t<p><label>We continue to think of other amazing ideas and activities to expand our program in the future. Please check all that you are interested in participating in.<\/label>\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"future-interests\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"future-interests[]\" value=\"In person games\"><span class=\"wpcf7-list-item-label\">In person games<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"future-interests[]\" value=\"In person events in Flushing (Queens)\"><span class=\"wpcf7-list-item-label\">In person events in Flushing (Queens)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"future-interests[]\" value=\"In person events in Washington Heights (Manhattan)\"><span class=\"wpcf7-list-item-label\">In person events in Washington Heights (Manhattan)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"future-interests[]\" value=\"Reading to the visually impaired\"><span class=\"wpcf7-list-item-label\">Reading to the visually impaired<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"future-interests[]\" value=\"Translation support\"><span class=\"wpcf7-list-item-label\">Translation support<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-future-interests\"><span class=\"wpcf7-form-control wpcf7-radio radio-hide-default\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-future-interests\" value=\"Default\" checked><span class=\"wpcf7-list-item-label\">Default<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-future-interests\" value=\"Other\"><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n\t<div data-id=\"group-future-interests-other\" data-orig_data_id=\"group-future-interests-other\" data-clear_on_hide class=\"\" data-class=\"wpcf7cf_group\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"future-interests-other\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"future-interests-other\"><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"bounding-box\">\n\t\t<h4>Are you interested in any of the following topics?\n\t\t<\/h4>\n\t\t<p class=\"fine-text\">Select as many as you like\n\t\t<\/p>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"following-topics\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"following-topics[]\" value=\"Bereavement support\"><span class=\"wpcf7-list-item-label\">Bereavement support<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"following-topics[]\" value=\"Digital literacy\"><span class=\"wpcf7-list-item-label\">Digital literacy<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"following-topics[]\" value=\"Staying in your home as you age\"><span class=\"wpcf7-list-item-label\">Staying in your home as you age<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"following-topics[]\" value=\"Staying mentally sharp\"><span class=\"wpcf7-list-item-label\">Staying mentally sharp<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"following-topics[]\" value=\"Staying physically healthy\"><span class=\"wpcf7-list-item-label\">Staying physically healthy<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"following-topics[]\" value=\"Other\"><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div data-id=\"group-following-topics-other\" data-orig_data_id=\"group-following-topics-other\" data-clear_on_hide class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"following-topics-other\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"following-topics-other\"><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"bounding-box\">\n\t\t<h4>How did you hear about the M2M program?\n\t\t<\/h4>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"how-did-you-hear\"><span class=\"wpcf7-form-control wpcf7-radio column-style radio-hide-default\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"how-did-you-hear\" value=\"Default\" checked><span class=\"wpcf7-list-item-label\">Default<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"how-did-you-hear\" value=\"Care Manager referral\"><span class=\"wpcf7-list-item-label\">Care Manager referral<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"how-did-you-hear\" value=\"Elderplan newsletter\"><span class=\"wpcf7-list-item-label\">Elderplan newsletter<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"how-did-you-hear\" value=\"Elderplan website\"><span class=\"wpcf7-list-item-label\">Elderplan website<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"how-did-you-hear\" value=\"Existing member referral\"><span class=\"wpcf7-list-item-label\">Existing member referral<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"how-did-you-hear\" value=\"Other\"><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div data-id=\"group-how-did-you-hear-other\" data-orig_data_id=\"group-how-did-you-hear-other\" data-clear_on_hide class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"how-did-you-hear-other\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"how-did-you-hear-other\"><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div data-id=\"group-name-care-manager\" data-orig_data_id=\"group-name-care-manager\" class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t<p><label class:label-bold>Name of the Care Manager (If Care Manager referral selected)<\/label>\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"care-manager-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"care-manager-name\"><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-4\" style=\" \">Previous Page<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-4\" style=\" \">Next Page<img decoding=\"async\" src=\"https:\/\/www.elderplan.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.elderplan.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\"><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n\n<div class=\"m2m-join\">\n\t<div class=\"screen-reader-response\">\n\t\t<div role=\"status\" aria-live=\"polite\">\n\t\t<\/div>\n\t<\/div>\n\t<h2>Signature &amp; Disclaimers\n\t<\/h2>\n\t<p>Please review our disclaimers and sign below.\n\t<\/p>\n\t<h4>Anti-Discrimination Statement\n\t<\/h4>\n\t<p><br>\nElderplan is an HMO plan with Medicare and Medicaid contracts. Enrollment in Elderplan depends on contract renewal. Elderplan, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.\n\t<\/p>\n\t<p>ATTENTION: If you speak a non-English language or require interpretation assistance, language assistance services and appropriate auxiliary aids are available to you free of charge. If you need these services or have questions about our plan, call <a href=\"tel:+18003533765\">1-800-353-3765<\/a> (TTY: 711). Elderplan, Inc. cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. ATENCI\u00d3N: Si usted habla en un idioma que no es ingl\u00e9s o requiere asistencia de interpretaci\u00f3n, tiene a su disposici\u00f3n servicios de asistencia ling\u00fc\u00edstica y las ayudas auxiliares adecuadas de forma gratuita. Si necesita estos servicios o tiene preguntas sobre nuestro plan, llame al <a href=\"tel:+18003533765\">1-800-353-3765<\/a> (TTY: 711). Elderplan, Inc. \u9075\u5b88\u9069\u7528\u7684\u806f\u90a6\u6c11\u6b0a\u6cd5\u5f8b\u898f\u5b9a\uff0c\u4e0d\u56e0\u7a2e\u65cf\u3001\u819a\u8272\u3001\u6c11\u65cf\u8840\u7d71\u3001\u5e74\u9f61\u3001\u6b98\u969c\u60c5\u6cc1\u6216\u6027\u5225\u800c\u6b67\u8996\u4efb\u4f55\u4eba\u3002\u8acb\u6ce8\u610f\uff1a\u5982\u679c\u60a8\u8aaa\u82f1\u8a9e\u4ee5\u5916\u7684\u8a9e\u8a00\u6216\u9700\u8981\u53e3\u8b6f\u5354\u52a9\uff0c\u6211\u5011\u5c07\u514d\u8cbb\u70ba\u60a8\u63d0\u4f9b\u8a9e\u8a00\u5354\u52a9\u670d\u52d9\u548c\u9069\u7576\u7684\u8f14\u52a9\u5de5\u5177\u3002\u5982\u679c\u60a8\u9700\u8981\u9019\u4e9b\u670d\u52d9\u6216\u5c0d\u6211\u5011\u7684\u8a08\u5283\u6709\u7591\u554f\uff0c\u8acb\u81f4\u96fb <a href=\"tel:+18003533765\">1-800-353-3765<\/a> (TTY: 711)\u3002\n\t<\/p>\n\t<h4>Disclaimers\n\t<\/h4>\n\t<p><br>\nElderplan is a HIPAA Covered Entity and as such will not share your personal information to any third parties for commercial or non-healthcare related purposes. However, by participating in this program you may choose to share personal information with other members at your discretion. Elderplan has no control over the use and misuse of information shared by you with other members. Elderplan strongly recommends that members do not post, or share private information received from other members on social media platforms.\n\t<\/p>\n\t<p><br>\nFor example, if you request pharmacy pick up, Elderplan may share the names of your medication with the volunteer who will help with your pharmacy pickup service.\n\t<\/p>\n\t<p><br>\nAlso, if you participate in this program, you may choose to share personal information with other Elderplan members at your discretion. Elderplan has no control over the use or misuse of information shared by you with other members. Elderplan also strongly recommends that members do not post or share private information received from other members on social media platforms.\n\t<\/p>\n\t<p><br>\nElderplan recommends that you check with your doctor before beginning any new physical activities.\n\t<\/p>\n\t<p><label for=\"signature-name\" class=\"label-bold\">Type Signature:<\/label>\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"signature-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"signature-name\"><\/span>\n\t<\/p>\n\t<p><label for=\"date-signed\" class=\"label-bold\">Date:<\/label>\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"date-signed\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-signed\"><\/span>\n\t<\/p>\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\">\n\t<\/p>\n<\/div>\n<div class=\"cf7mls-btns cf7mls-btns-last-step\"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-5\" style=\" \">Previous Page<\/button><button type=\"button\" style=\"display: none;\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-5\"><img decoding=\"async\" src=\"https:\/\/www.elderplan.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/www.elderplan.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\"><\/button>\n<\/div><input type=\"hidden\" class=\"wpcf7-pum\" value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}'><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n\n<\/fieldset><\/div>\n\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\">\n\n\n\n<h2 class=\"wp-block-heading\" id=\"FAQs\">\u00bfC\u00f3mo me uno a la Comunidad Member-to-Member?<\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>\u00danase en l\u00ednea<\/strong> ahora completando nuestra <a href=\"\/es\/member-benefits\/member-to-member-community\/member-to-member-application\/#form\">solicitud simple y segura<\/a>.<\/li>\n\n\n\n<li><strong>\u00danase por correo electr\u00f3nico<\/strong> descargando el <a href=\"https:\/\/elderplan.us-east-1.linodeobjects.com\/2025-M2M-Application-Form_UPT5.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">formulario de solicitud<\/a> para completarlo y luego enviarlo por correo electr\u00f3nico a: <a href=\"mailto:m2m@mjhs.org\">m2m@mjhs.org<\/a>.<\/li>\n\n\n\n<li><strong>\u00danase por tel\u00e9fono<\/strong> llamando a la l\u00ednea directa de Member-to-Member al <a href=\"tel:1-347-254-7700\">1-347-254-7700<\/a> (TTY: <a href=\"tel:711\">711<\/a>), de 9:00 a.m. a 5:00 p.m., de lunes a viernes.<\/li>\n\n\n\n<li><strong>\u00danase por correo<\/strong> descargando el <a href=\"https:\/\/es-us-rgtbsyae-p.proxy.cqfluency.com\/wp-content\/uploads\/2023_m2m_application_fillable_12.30.22_Accessible.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><a href=\"https:\/\/elderplan.us-east-1.linodeobjects.com\/2025-M2M-Application-Form_UPT5.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">formulario de solicitud<\/a> para completarlo y luego enviarlo por correo a:<br>MJHS Member-to-Member program<br>55 Water Street, 46<sup>th<\/sup> Floor, Suite 202<br>New York, NY 10041<\/li>\n<\/ol>\n<\/form><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"600\" height=\"400\" src=\"https:\/\/elderplan.imgix.net\/2021\/04\/iStock-874791754_RF.jpg?fm=pjpg\" alt=\"Man on laptop\" class=\"wp-image-12148\" srcset=\"https:\/\/elderplan.imgix.net\/2021\/04\/iStock-874791754_RF.jpg?fit=scale&amp;fm=pjpg&amp;h=853&amp;w=1280 1280w, https:\/\/elderplan.imgix.net\/2021\/04\/iStock-874791754_RF.jpg?fit=scale&amp;fm=pjpg&amp;h=1024&amp;w=1536 1536w, https:\/\/elderplan.imgix.net\/2021\/04\/iStock-874791754_RF.jpg?fit=scale&amp;fm=pjpg&amp;h=1365&amp;w=2048 2048w, https:\/\/elderplan.imgix.net\/2021\/04\/iStock-874791754_RF.jpg?fm=pjpg 600w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\"><\/figure>\n\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-unase-a-nuestra-comunidad\">\u00a1\u00danase a nuestra comunidad!<\/h2>\n\n\n\n<p>Complete la solicitud en l\u00ednea de forma segura y siguiendo unos simples pasos. Comience con su n.\u00b0 de identificaci\u00f3n de miembro de Elderplan o HomeFirst. Es el n\u00famero que <strong>aparece junto al n.\u00b0 de identificaci\u00f3n de miembro en su tarjeta de beneficios de Elderplan<\/strong>.\u00a0Luego le haremos preguntas sobre usted y sus intereses.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"890\" height=\"557\" src=\"https:\/\/elderplan.imgix.net\/2022\/06\/Ep_Card.png?fm=png\" alt=\"Image of the Elderplan benefits card with sample ID numbers and participant name\" class=\"wp-image-15380\" srcset=\"https:\/\/elderplan.imgix.net\/2022\/06\/Ep_Card.png?fit=scale&amp;fm=png&amp;h=481&amp;w=768 768w, https:\/\/elderplan.imgix.net\/2022\/06\/Ep_Card.png?fit=scale&amp;fm=png&amp;h=801&amp;w=1280 1280w, https:\/\/elderplan.imgix.net\/2022\/06\/Ep_Card.png?fit=scale&amp;fm=png&amp;h=961&amp;w=1536 1536w, https:\/\/elderplan.imgix.net\/2022\/06\/Ep_Card.png?fit=scale&amp;fm=png&amp;h=1282&amp;w=2048 2048w, https:\/\/elderplan.imgix.net\/2022\/06\/Ep_Card.png?fm=png 890w\" sizes=\"auto, (max-width: 890px) 100vw, 890px\"><\/figure>\n\n\n\n<p>Lea las <a href=\"\/es\/member-benefits\/member-to-member-community\/member-to-member-application\/#FAQs\">Preguntas frecuentes<\/a> para obtener m\u00e1s informaci\u00f3n sobre c\u00f3mo enviar la solicitud.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-obtenga-todos-los-beneficios-de-la-membresia\">Obtenga todos los beneficios de la membres\u00eda<\/h3>\n\n\n\n<p>Nuestra comunidad les ofrece a los miembros una oportunidad de conectarse entre ellos y disfrutar de una variedad de <a href=\"\/es\/member-benefits\/member-to-member-community\/events-activities\/\">eventos y actividades<\/a>.<\/p>\n<\/div>\n<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Complete la solicitud en l\u00ednea de forma segura y siguiendo unos simples pasos. Comience con su n.\u00b0 de identificaci\u00f3n de miembro de Elderplan o HomeFirst. Es el n\u00famero que aparece [&hellip;]<\/p>\n","protected":false},"author":21,"featured_media":0,"parent":12136,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-37169","page","type-page","status-publish","hentry"],"translation":{"provider":"WPGlobus","version":"3.0.2","language":"es","enabled_languages":["en","es","zh"],"languages":{"en":{"title":true,"content":true,"excerpt":false},"es":{"title":true,"content":true,"excerpt":false},"zh":{"title":true,"content":true,"excerpt":false}}},"acf":[],"jetpack_sharing_enabled":true,"publishpress_future_action":{"enabled":false,"date":"2026-04-28 13:31:57","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/pages\/37169","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/users\/21"}],"replies":[{"embeddable":true,"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/comments?post=37169"}],"version-history":[{"count":0,"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/pages\/37169\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/pages\/12136"}],"wp:attachment":[{"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/media?parent=37169"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}