Welcome To The PTKC Membership Application Page

On this page you can:

■ Download and print the paper version of the 1 person Membership Application form. Then you can complete the form and send it, along with your check for dues payment, by regular mail.

■ Download and print the paper version of the 2 person Membership Application form. Then you can complete the form and send it, along with your check for dues payment, by regular mail.

■ Complete and submit the Online Membership Application Form Below:

Please enable JavaScript in your browser to complete this form.

- Step 1 of 11

New Member Application

You can use this form to submit a New Member Application, for 1 or 2 people.

Just answer the questions. The form will guide you through the process.

When you select the "Submit" button at the end of the form, you will receive an email that will contain a copy of the information that you have submitted. It will also be submitted to PTKC. The email will be sent to the address that you entered in your "email" box.

You will be sent to the Payments Options page, where you will then have the opportunity to pay online, or by check. Just select the appropriate button at the bottom of the page. You will be sent to the Stripe payments site where you can securely pay online, if you wish. Otherwise, you can send your dues, by check, using the US mail or hand it to a member of the Board.

Is This New Member Application for 1 person or 2 People? *

1 person
2 people

Please choose one of the above

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Your Name *

First

Last

Please enter your name. If you have a nickname, please place that in quotation marks with your first name.

Your Email *

Please enter your full email address

Your Mobile Phone *

Please enter your mobile phone number, area code first

Name For Person 2 *

First

Last

Please enter the name of person 2. If you have a nickname, please place that in quotation marks with your first name.

Email 2 For Person 2 *

Please enter the full email address for person 2

Mobile Phone For Person 2 *

Please enter the mobile phone number for person 2, area code first

Home Phone

If you have a home phone number, please enter it here, area code first.

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Your Address *

Address Line 1

Address Line 2

City

State

Zip Code

Please complete the above information

Do both of you live at the same address? *

Please select the appropriate response

Address For Person 2 *

Address Line 1

Address Line 2

City

State

Zip Code

Please complete the above information for Person 2

Your Birthday *

Please enter your birthday

Birthday For Person 2 *

Please enter the birthday for person 2

Are You Married or Do You Have a Partner? *

Yes, I am married
No, I am not married
Yes, I have a partner
No, I do not have a partner
I neither have a partner nor am I married

Please select one answer

Anniversary Date *

Please enter your anniversary date

Please Enter Your Husband or Partner's Name *

Enter your husband or partner's name

Your Occupation *

Please enter your current or previous life's work

I am ... *

Currently working
Semi-retired
Retired

Please enter your current work status

Occupation For Person 2 *

Please enter the current or previous life's work for Person 2

Person 2 is... *

Currently working
Semi-retired
Retired

Please enter the current work status for person 2

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We at PTKC privacy is very important to us and we take it very seriously. We do not share this information with, nor distribute it to, any other organization. The Membership Directory is distributed only to other PTKC members. The Membership Directory is published once a year and occasionally updated. Electronic copies, including updates, are distributed directly to our members, via email, and posted in the password protected, Members Only portion of our website. Your last name will not be listed in the newsletter, only your last initial.

Your Privacy Choices *

I wish to be listed normally, with all information
Please list me, but with the following restrictions
I do not wish to be listed in the directory (not recommended)

Please select one

Your Restriction Choices (click all that apply). List me in the PTKC Directory, but do not include:

Last Name, use the initial of my last name only
Street Address
City and State
Phone Number(s)
Email Address.

Please select all that apply

Privacy Choices for Person 2 *

I wish to be listed normally, with all information
Please list me, but with the following restrictions
I do not wish to be listed in the directory (not recommended)

Please select one

Restriction Choices for Person 2 (click all that apply). List me in the PTKC Directory, but do not include: *

Last Name, use the initial of my last name only
Street Address
City and State
Phone Number(s)
Email Address.

Please select all that apply

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Your Picture: Do you want Your Picture To appear in the PTKC Membership Directory? *

Yes, I would like to send 1 or two pictures to use in the PTKC Directory
Yes, I want my picture included in the PTKC Directory, but I don't want to send a picture at this time. Or, you can use the picture that I have already sent to PTKC. (Note: You can send a picture later, if you wish. Send it to primetimerskc@gmail.com)
No, I do not want my picture included in the directory.

Please select the one answer that applies to you. Most PTKC members include their picture in the roster.

Picture For person 2: Do you want Your Picture To appear in the PTKC Membership Directory? *

Yes, I would like to send 1 or two pictures to use in the PTKC Directory
Yes, I want my picture included in the PTKC Directory, but I don't want to send a picture at this time. Or, you can use the picture that I have already sent to PTKC. (Note: You can send a picture later, if you wish. Send it to primetimeerskc@gmail.com;.
No, I do not want my picture included in the directory.

Please select the one answer that applies to you. Most PTKC members include their picture in the roster.

PTKC Newsletter: Copies of our newsletter may be shared with other PrimeTimer chapters and may be distributed at other places for publicity or member recruitment. Last names are always omitted from our website, newsletter, and Facebook page. We only use last ititials.

Note: If you do not want your picture to appear in the newsletter, on the website, or on the our Facebook page, please inform the photographer at the time the picture is taken.

File Upload

Click or drag files to this area to upload. You can upload up to 2 files.

Please upload up to 4 picture files here.

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How Did You Learn About PTKC? *

I was referred by someone
Web search
Advertisement
Other

Please select one

Who Referred You To PTKC? *

Please enter the name of the person that referred you

You Selected "Other" Referral Above, Please Specify. *

Please Enter the "Other" Information

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PTKC has many activities of interest for our members. Here are some current activities. Please check those that interest you or suggest other interest(s).

Your Interests: *

Antiques
Architecture
Art
Ballet
Bicycling
Book Group
Bowling
Bridge
Computers
Concerts
Cooking
Dancing
Dining Out
Dominoes
Flea Market
Gardening
Hearts
Movies
Museums
Opera
Photography
Pickleball
Pinochle
Poker
Potluck
Social Nudism
Swimming
Sports
Theatre
Travel
Walking
Wine
Other

Please select all that apply.

Your Other Interests: *

Please specify

Person 2 Interests:

Antiques
Architecture
Art
Ballet
Bicycling
Book Group
Bowling
Bridge
Computers
Concerts
Cooking
Dancing
Dining Out
Dominoes
Flea Market
Gardening
Hearts
Movies
Museums
Opera
Photography
Pickleball
Pinochle
Poker
Potluck
Social Nudism
Swimming
Sports
Theatre
Travel
Walking
Wine
Other

Please select all that apply.

Person 2 Other Interests: *

Please specify "Other" interests

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PTKC is an all volunteer organization. Therefore, we need everyone's help for many of our activities. While PTKC has a Board of Directors who plan many of our activities, we couldn't operate without other members pitching in and helping. How are you willing to help?

Your Volunteer Preferences: *

Host a PTKC event
Organize an event
Help at an event
Serve on a committee
Serve on the Board
Serve as the Webmaster
Serve as the Newsletter Editor
Be profiled in the Newsletter
I have a car and am willing to help other members without transportation
Other

Please check all that apply

In what other way(s) would you like to help?

Specify your choice(s)

Your Committee Preferences: *

Care Committee
Events Committee
Financial Audit Committee
Nominating Committee
Website Committee
I am not interested in serving on any committies

Please select all that apply

Would you be willing to speak to a PTKC gathering or teach a class? If so, please specify your interest.

Please enter your area(s) of expertise

Person 2 Volunteer Preferences: *

Host a PTKC event
Organize an event
Help at an event
Serve on a committee
Serve on the Board
Serve as the Webmaster
Serve as the Newsletter Editor
Be profiled in the Newsletter
I have a car and am willing to help other members without transportation
Other

Please check all that apply

Person 2, In what other way(s) would you like to help? *

Specify your choice(s)

Person 2 Committee Preferences: *

Care Committee
Events Committee
Financial Audit Committee
Nominating Committee
Website Committee
I am not interested in serving on any committies

Please select all that apply for person 2

Would Person 2 be willing to speak to a PTKC gathering or teach a class? If so, please specify your interest.

Please enter your area(s) of expertise

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Many of our members live alone. Is there an emergency contact that you will want us to contact if we suspect you might be in trouble? If so, please provide the following information.

Emergency Contact Name For You

First

Last

Please enter emergency contact name

Relationship to You

Please enter the relationship

Your Emergency Contact Phone or Email

Please enter at least one specific way to contact this person

Emergency Contact Name For Person 2

First

Last

Please enter emergency contact name

Relationship to Person 2

Please enter the relationship

Your Emergency Contact Phone or Email For Person 2

Please enter at least one specific way to contact this person

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I (we) intend to pay my (our) annual dues using the following method:

Pay online using a credit card (follow the link as selecting the "Submit" button, below)
I will send a check in the mail

Please select your intended payment method

By typing my signature below, I affirm that I will faithfully attend as many PTKC functions as possible and that I will help at as many PTKC events as possible.

Also, I consideration for being allowed to participate in activities offered by PTKC, I hereby release, waive, discharge, and covenant not to sue PTKC officers, volunteers, agents, and successors in interest from any and all claims, damages, liabilities, costs, and expenses of any kind arising out of or in any way related to my participation in PTKC activities, including but not limited to personal injury, death, and property damage.

Also, I pledge to maintain up-to-date COVID 19 booster shots as they become available. I understand that this is a requirement in order to attend any and all PTKC functions and events. This requirement exists to protect all of our members.

I also understand that PTKC reserves the right to deny or revoke any membership for cause.

By typing my name here, I affirm my commitment to the above statements. *

Please type your name

Please Enter The Date You Signed *

Enter today's date

By typing my name here, I, Person 2, affirm my commitment to the above statements. *

Please type your name

Please Enter The Date Person 2 Signed *

Please enter today's date

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Thank you for completing your PTKC New Member Application online. You can either pay your dues by check or online. After selecting the "Submit" button, below, you will be redirected to the Payment Options Page.

Custom Captcha *

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Heads up! Saving your progress now will store a copy of your entry on this server and PTKC may have access to it. For security reasons, sensitive information such as credit cards and mailing addresses, along with file uploads will have to be re-entered when you resume.

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Your form entry has been saved and a unique link has been created which you can access to resume this form.

Enter your email address to receive the link via email. Alternatively, you can copy and save the link below.

Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.

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