2009-Renewal Application
( You
Must Complete Both Sides and Sign Page Two )
Please Print all Information
Name:
________________________________________________________
Address:
______________________________________________________
City: _____________________________
State: ____ Zip: _______________
( 9-Digit Zip
Code )
Phone: _____________________________
( 10-Digit Phone Number )
E-mail:
______________________________________________________
As an
active PTTB Member, I will volunteer to work in the following areas:
(Please circle all that apply)
Board Member - Communication - Web site - Host Events
- Special Projects
My Interest's Include: (Please X all that
apply on page 2 of this application)
Calendar year Dues: (Jan 1st - Dec
31st)
$20.00 per person for email
Newsletter
$30.00 per person for USPS delivery of the Newsletter
Paid: $ ____________ Date:
__________ Check # _________________
Please send completed form to:
PTTB
Revised: 02/10/2009 BC
2009
MEMBER INTERESTS-Renewal
I am interested in
contacting and being contacted by fellow PTTB members who have the same
interests as I do.
NOTE: Please put an X mark to the left of all the activities
in which you are interested. We would like to get those interested in the
various activities together in order to enjoy the activity as a group.
|
# |
X |
PUT AN X IN BOX ON LEFT |
# |
X |
PUT AN X IN BOX ON LEFT |
|
1 |
|
Antiques |
39 |
|
Literature-Best Sellers |
|
2 |
|
Art-Ceramics |
40 |
|
Literature-Book Exchange |
|
3 |
|
Art-Painting |
41 |
|
Literature-Book Reviews |
|
4 |
|
Art-Sculpture |
42 |
|
Museums-Art |
|
5 |
|
Art-Stained Glass |
43 |
|
Museums-History |
|
6 |
|
Beach |
44 |
|
Music-Blues |
|
7 |
|
Camping |
45 |
|
Music-Choral Concerts |
|
8 |
|
Drag Shows |
46 |
|
Music-Country |
|
9 |
|
|
47 |
|
Music-Jazz |
|
10 |
|
Exotic-Naturist Parties |
48 |
|
Music-Musical Theater |
|
11 |
|
Exotic-One on One Encounters |
49 |
|
Music-Opera |
|
12 |
|
Flea Markets |
50 |
|
Music-Pop Concerts |
|
13 |
|
Food-Brunch |
51 |
|
Music-Rock |
|
14 |
|
Food-Fine Dining |
52 |
|
Music-Symphony |
|
15 |
|
Food-Koffee
Klatches |
53 |
|
|
|
16 |
|
Food-Luncheons |
54 |
|
Parks-Disney |
|
17 |
|
Food-Picnics |
55 |
|
Parks-Homosassa |
|
18 |
|
Games-Board Games |
56 |
|
Parks-Sea World |
|
19 |
|
Games Card-Bridge |
57 |
|
Sports Spectator-Baseball |
|
20 |
|
Games Card-Canasta |
58 |
|
Sports Spectator -Basketball |
|
21 |
|
Games-Chess |
59 |
|
Sports-Boating |
|
22 |
|
Games-Dominos |
60 |
|
Sports-Fishing |
|
23 |
|
Games Card-Golf |
61 |
|
Sports Spectator -Football |
|
24 |
|
Games Card-Hand & Foot |
62 |
|
Sports-Golf |
|
25 |
|
Games Card-Hearts |
63 |
|
Sports Spectator -Hockey |
|
26 |
|
Games Card-Pinochle |
64 |
|
Sports-Swimming |
|
27 |
|
Games Card-Pitch |
65 |
|
Sports-Tennis |
|
28 |
|
Games Card-Poker |
66 |
|
Sports Spectator -Wrestling |
|
29 |
|
Games Card-Uno |
67 |
|
Theatre-Gay Porn Movie Nights |
|
30 |
|
|
68 |
|
Theatre-Gay Themed Movie Nights |
|
31 |
|
Hiking |
69 |
|
Theatre-Live Theater |
|
32 |
|
Hobbies-Antique Cars |
70 |
|
Trips-Camp David |
|
33 |
|
Hobbies-Ceramics |
71 |
|
Trips-Cruise Ships |
|
34 |
|
Hobbies-Cooking |
72 |
|
Trips-Day trips |
|
35 |
|
Hobbies-Gardening |
73 |
|
Trips-Overnight Trips |
|
36 |
|
Hobbies-Genealogy |
74 |
|
Trips-Sawmill Campground |
|
37 |
|
Hobbies-Photography |
75 |
|
Walking |
|
38 |
|
Hobbies-Woodworking |
76 |
|
Zoos |
Put an X
here _____ if you have no interests and dont want to be contacted.
I certify
that I am at least 21 years of age.
I agree to
uphold and abide by the Tampa Bay Prime Timers by-laws.
I, and any
guest(s) of mine agree to absolve Tampa Bay Prime Timers, its Board of
Directors and all other members of any liability due to my (our) participation
in Tampa Bay Prime Timers group activities.
Signature:
________________________________________ Date: _________________________
Rev: 02/10/2009 BC