Application Form - Portland Metro Prime Timers

Portland Metro Prime Timers Membership Application & Renewal Form

Application accepted from men age 21 and over.

Annual Membership Fees:
Individual $25.
Household $35
Fees are 1/2 Price July thru end of year.

Please note: Dues & Donations are NOT tax deductible.

Your application will be processed only after payment is received.

You may:
- Submit this application & then make payment at a Saturday Dinner. OR
- Attend a Saturday Dinner & give the completed .pdf form to any board member. Note: Payment by check must be given directly to Treasurer or Chapter President. Make check payable to: Portland Metro Prime Timers. No cash payments.

For questions about membership, please contact us at info@portlandprimetimers.org.

Name

First

Last

Preferred Name on Badge

Phone

Birthday (MM/DD)

Name Badge (MM/DD/YYYY)

Like to be a Volunteer?

Partner's Name

First

Last

Partner's Phone

Partner's Email

Partner's Birthday (MM/DD)

Partner Like to be a Volunteer?

Address

Address Line 1

Address Line 2

City

State

Zip Code

As a member you understand agree that:

"PMPT does not tolerate discrimination based on age, race, color, ancestry, religious or political belief, sexual orientation, gender identity, national, ethnicity or social origin, marital or veteran status, income, HIV status or disability.

PMPT does not host or promote activities or events of a sexual nature.

You will NOT display or share personal telephone numbers, private e-mail addresses or other member information, unless pre-approved by that owner.

Any person who is disruptive, disrespectful or speaks in a manner contrary to these or other PMPT policies may have their membership revoked.

PMPT disclaims any responsibility for incidents that may lead to loss, injury, or death to individuals involved in PMPT-related activities or events. By participating, you agree to indemnify and release PMPT, its Board Members, and any event hosts, sponsors, or participants from liability. It is understood that all members engage in PMPT activities at their own risk. Your submission of this signed document confirms your acceptance of these policies and verifies that you are at least 21 years old."

Media Consent: By signing up to become a member of Portland Metro Prime Timers, you agree that your image and likeness may be used in media promotion materials, including but not limited to our newsletter and website. However you do have the option, when attending a PMPT-sponsored or PMPT-endorsed event, to notify the photographer if you do not wish to be photographed. Thank you for being a part of our vibrant and supportive community!

Signature & Date (MM/DD/YYYY)

Clear Signature

Once you click the Submit Online Application button you will receive a message "Thanks for submitting your online application to PMPT!". This confirms that the application has been properly filled out and sent to us. If you do not receive the confirmation message please check your entries for errors and resubmit. You will also receive an email with a copy of the submitted application to retain for your records. Thank you!