Online Membership Application

Brand New!

Name *

First

Last

Contact Phone ###-###-#### *

Type of Phone *

Email *

Is it okay to contact you by email? *

Street Address *

City *

State *

Zip Code *

Birthday MM/DD

Would you like to be listed in the PTGR Membership Directory? *

If "Yes", which of the following would you like listed in the PTGR Directory? (Check as many as you wish)

Membership in PTGR also includes membership in PrimeTimers® Worldwide (Select one option) *

Dues are $15 - I am a current PTGR member renewing by January 31st. ($16 if paying online through Square)
Dues are $20 - I am a current PTGR member renewing after January 31st ($21 if paying online through Square)
Dues are $15 - I am a new member to PTGR ($16 if paying online through Square)

Payment

Notice

Please click the box indicating that you agree with the text in the Notice section of this application. *

Signature (Typing in your name will be considered your signature) *

Date: MM/DD/YYYY *

I am a current PTGR member renewing by January 31st. Fee is $16.

Pay now

I am a current PTGR member renewing after January 31st. Fee is $21.

Pay now

I am a new member to PTGR. Fee is $16.

Pay now