New Member Registration Form

Complete the form below to request membership in Prime Timers of Central Virginia.
Use parentheses if specifying your nickname.
Keep my member profile private?
Most members do not request private profiles. Those who select "Yes" will not see their name on the list of members published for all members. Continuing on this form below, you can designate other personal information as only available to the Board and staff and not to the general membership.
Date of Birth
Birthday Privacy?
Choosing "Yes" will keep your birthday private to the general membership and we will not publish your birthday on the monthly Member Calendar. We required your date of birth when you register and is retained for reference only by the Board and the membership coordinator.
Date of Anniversary
Will be published on the PTCV Monthly Calendar unless made private.
If you have an email, please do not leave this field blank. If you do, you will not receive email updates. You can opt to receive paper copies. See below.
Paper copies via U.S. Mail? (extra $15/year dues)
The extra $15 dues help us cover the costs of inks and postage.
Emailed Member Updates?
Choose "No" if you do not want us to email you periodic Member Updates.
Email Privacy
If you choose "Yes", only the Board and staff will be able to see email address and it won't be available to the general membership.
This field is required.
Main Phone Privacy?
If you choose "Yes", only the Board and staff will be able to see this phone number and it won't be available to the general membership.
Alternate Phone Privacy?
If you choose "Yes", only the Board and staff will be able to see this phone number and it won't be available to the general membership.
Address Privacy
If you choose "Yes", only the Board and staff will be able to see your address and it won't be available to the general membership.
If you like, tell our members anything about you such as why you joined, what your activities and interests are, anything else you'd like to share with our group. You can update this any time on our Member Profile Update form.