Online Application

To complete your application online, please fill out the fields below and click the submit button. Fields with a red * are required.

Name *

First

Last

Street Address *

City *

State *

Zip Code *

Phone *

Can you receive PTDFW text messages? *

Birthday (MM/DD) *

Email *

Is it okay to send you emails? *

Do you want to be listed in the PTDFW roster? *

Does PTDFW have permission to use your photo when taken at group events? *

How did you learn about Prime Timers?

Pay $37 online using Square. OR
Present in-person at a selected PTDFW event. OR
Mail a check (please do not send cash) payable to: PrimeTimers Dallas-Fort Worth, P.O. Box 191101, Dallas, TX 75219-8101

Please check the box to indicate that I agree to the following when I sign and submit this application. *

I wish to join PTDFW, and I am at least 21 years of age. As a member, I agree to keep the membership roster PRIVATE and CONFIDENTIAL. I further understand that my membership application is pending final approval from the Board of Directors, whether as a renewal or first-time applicant.

Signature *

Signature Date (MM/DD/YYYY) *

$37.00

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