PTKC Membership Renewal Application

PTKC Membership Renewal

■ Download and print the paper version of the Membership Renewal form for 2026. Then you can complete the form and send it, along with your check for dues payment, by regular mail.

■ Then, click here for dues payment options.

■ Complete and submit the Online Membership Renewal Form Below:

Please enable JavaScript in your browser to complete this form.

- Step 1 of 6

You can use this form to submit a Membership Renewal (for current members) for 1 or 2 people.

Just answer the questions. This 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 then 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 PTKC Membership Renewal for 1 person or 2 People? *

1 Person
2 People

Please choose one response

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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 Phone *

Please enter your phone number, area code first.

Is Your Phone Number Above a Cell Phone? *

Please provide the appropriate response

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 For Person 2 *

Please enter your full email address

Phone For Person 2 *

Please enter your phone number, area code first.

Is Person 2's Phone Number Above a Cell Phone? *

Please provide the appropriate response

If There Is Any Information, From Previous Submissions, That You Wish US To Change, Please List That Changed Information Below.

Please list any needed changes, or choose next

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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.

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 primetimerskc@gmail.com)
No, I do not want my picture included in the directory.

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

Upload Your Picture(s) Here

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

You can upload your pictures here. Each file must be less than 5 MB in s size.

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 omitted from our website, newsletter, and Facebook page. We only use last initials.

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.

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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 for Person 1 *

Host a PTKC event
Serve on the Board
Organize an event
Serve on a committee
Help at an event
Serve as the webmaster/help with the website
Be profiled in the newsletter
Serve as the newsletter dditor
I have a car and am willing to help other members that need transportation
Other

Select all that apply

You selected "Other". In what other way(s) would you like to help? - Person 1 *

Please answer the question.

Committee Preferences for Person 1

Care Committee
Events Committee
Finance Committee
Nominating Committee
Website Committee
I made a mistake. I am not interested in serving on any committees

Please select all that apply.

Your Volunteer Preferences for Person 2 *

Host a PTKC event
Serve on the Board
Organize an event
Serve on a committee
Help at an event
Serve as the webmaster/help with the website
Be profiled in the newsletter
Serve as the newsletter dditor
I have a car and am willing to help other members that need transportation
Other

Select all that apply

You selected "Other". In what other way(s) would you like to help? - Person 2 *

Please answer the question.

Committee Preferences for Person 2 *

Care Committee
Events Committee
Finance Committee
Nominating Committee
Website Committee
I made a mistake. I am not interested in serving on any committees

Please select all that apply.

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I (we) intend to pay my/our dues as indicated below (after you select "Submit" below you will be redirected to the payments options page) *

I will pay online with a credit card
I will pay by check and send it by the US mail
I have already paid cash

Please indicate your intention

Please indicate the name of the person you paid the cash to *

Please enter the name

Please enter the date you paid cash *

Please enter the date

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, in 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 and ful shots as they become available. This request exists to protect the health of 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, Person 1, affirm my commitment to the above statements. *

Please type your name

Today's Date that Person 1 signed by typing their name *

Please 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 that Person 2 signed by typing their name *

Please enter today's date

Date PTKC you

Thank you for completing your PTKC renewal 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.

Save and Resume Later

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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Email *