Testing-Membership Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. We're so glad you're joining our family! Thanks for taking a moment to start your Prime Timers journey with this application. Just a few quick steps and you're done. Once sent, we'll review it and reach out to you shortly. Type of Membership Application: (Check one) *New MembershipRenewalApplicant Name *FirstLast Reading mail Dir-Secondary Birthday *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Do You have a Partner: *YesNoPartner's Name (Optional)FirstLastAnniversaryMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePrimary Phone *Secondary PhoneEmail *Other Paid Prime Timer AffiliationsDiscretion is paramount in all actions and activity of Miami Valley Ohio Prime Timers (MVOPT). Personal informatrin will be kept confidential unless you give permission below to publish all or part of it in Miami Valley Ohio Prime Timers' materials. I understand that the Prime Timers Roster is given only to Prime Timers members to be used by the chapter to conduct its business. Members and the chapters are to keep the rosters private and confidential. Check the items we can publish in our Member Directory: Dir-First NameYesDir-Last NameYesDir-BirthdayYesDir-Partner's NameYesDir-Anniversary DateYesDir-Mailing AddressYesDir-Primary PhoneYesDir-Secondary PhoneYesDir-Email AddressYesDir-AffiliationsYesHow to display Last Name in MVOPT Directory *Full Last Name1st Initial OnlyCan MVOPT mail Prime Timer materials to you? *YesNoCan MVOPT contact you by phone? *YesNoSelect preferred phone: *Primary PhoneSecondary PhoneMay MVOPT include your Affiliations? *YesNoCan MVOPT contact you via E-mail? *YesNoIf we need to contact you regarding event date/time changes, notifications that affect you, what means do you want us to use? *PhoneTextOtherThis application cannot be accepted unless ALL the following statements are acknowledged *I understand that the MVOPT Directory is given ONLY to Members for their personal useI agree to keep the MVOPT Directory and its contents private and confidentialI direct MVOPT newsletter to be sent via E-mailI understand that MVOPT does not discriminate based on race, color, creed, national origin, transgender, binary, gay, bisexual or HIV statusI understand that the use of illegal drugs is not permitted at any MVOPT functionI am at least 21 year of age-- $20 Annual Membership per person (Due Jan 31) -- Make checks payable to: Miami Valley Ohio Prime Timers -- Mail to address at the top of this form OR give to a MVOPT Board Member -- www.miamivalleyohioprimetimers.com Please select any interests or hobbies you enjoy and may want to share with others in a group (Check your Interests) Select AllSelect AllAir Force MuseumYesAntiques--CollectingYesBalletYesBicyclingYesBoard GamesYesBowlingYesCampingYesCard GamesYesChurchYesCollectingYesComputersYesCompanionshipYesComputer GamingYesConcerts--AttendingYesCookingYesDancingYesDining OutYesDiscussion GroupsYesEroticaYesExercisingYesFishingYesFlea Markets/Yard SalesYesGardeningYesGay BarsYesGenealogy Stamp/Coin CollectingYesHiking/WalkingYesLong Term RelationshipYesMassagesYesMovies/Theatre/Home VideosYesMuseums/Art GalleriesYesMusic Attending/ParticipatingYesNudism Singles/GroupsYesOperaYesPhotographyYesPickleballYesReadingYesSingingYesSkiingYesSwimmingYesSports--ObservingYesTheatre Attending/ParticipatingYesTheatre Plays/MusicalsYesTravel Day/WeekendsYesVolunteering/CommunityYesVFW Events/ActivitiesYesVisiting Shut-insYesCruisesYesHosting Theme PartyYesPlease tells us about any additional interests, services or concerns you would like MVOPT to considerEnter Full Name *Date (mm/dd/yyyy) *Submit
