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To apply for membership:
Please fill in the form and click on 'Apply' when finished. Important: Couples are recorded as one application.

This Application is for Individual Couple

First Name:

Last Name:

Street address:

City:

State:

Zip Code:

Home Phone:

 Format 000/000-0000 please.

Other Phone:

 Format 000/000-0000 please.

Fax:

 Format 000/000-0000 please
Emergency Contact:

Applicant

Spouse/Partner

E-mail:

Confirm E-mail:

Born Year-Month-Day:

Occupation
now or before retirement:

Retired : please check this box

Interest in Volunteering:

Elected Board/Officer:

Trip Leadership & Assist:
trip/campout leader, co-leader, or assistant
Club Support & Coordination:
Membership Coordinator, Activities Coordinator, Trip Treasurer, Web Support etc.

Activities:

DH Ski
XC Ski
Snowshoe
Hike
Camp
Canoe or Kayak
Golf
Tennis
Bike

Bridge

Other:

If applying as a couple provide following:

Spouse or Partner's First name:
Spouse or Partner's last name:

How did you hear of us? Did a member recommend us?

Name of any Referral:


Please select how you receive your copy of the Prime Times. This choice affects you and your partner if you are applying as a couple.

Internet Copy with Email notification.
USPS Mail Copy Only
Both USPS Mail and Email notification

How about the annual DIRECTORY? Would you use the Web Site instead of asking for a printed copy? Note:Your website has ALL the directory information AND is ALWAYS up to date for member information.

Select Website Directory this year
Select Printed Directory this year
Select Printed Directory & Volunteer to help assemble the Directory