CPT – Online Application Form

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Your Name *

First

Last

Your Street Address (include apartment, suite, our unit # if applicable) *

City *

State/Province *

Zip/Postal Code *

Country *

Email *

Phone *

Your Birthday (MM/DD/YYYY) *

Add household member? *

Yes
No

Household Member's name *

First

Last

Household Member's Street Address (if different from above)

City

State/Province

Zip/Postal Code

Country

Household Member's Email

Household Member's Phone

Household Member's Birthday (MM/DD/YYYY)

Opt-In Notices

Newsletters - Select how do you wish to receive our Newsletters? Digital newsletters will include newsletters from other Prime Timer Chapters. *

Print
Digitial
No newsletter

Do you want to be listed on our roster? Rosters are available to members ONLY. Our roster is NEVER to be given out to any other individual or organizations. *

Yes
No

Media Release Permission. I give permission for my name(s) or photo(s) to be printed in any form (newsletter, the website, etc.). *

Yes
No

Your current or former occupation.

Hos did you hear about us? Select all that apply.

Social Networks (Facebook, Instagram, LinkedIn)
Meetup (Community Meetup website)
Word-of-mouth (friend, colleague, or family)
Internet Search
Colorado Prime Timers Website
Marketing (Newsletter; flyer, gay dating app)
Event (Beerbust, Pride)

Other Comments - Are there any other details that you would like to tell us about yourself? Household member?

Legal Notices

By clicking the below box. I certify that I am at least 21 years of age. I agree to uphold and abide by the Colorado Prime Timers by-laws. I agree to absolve Colorade Prime Timers, its Board of Directors and all other members of any liability due to my participation in Colorado Prime Timers group activities. *

I agree

or wish Zip/Postal

Your Name *

Today's Date (MM/DD/YY) *