Printable Application

PrimeTimers®Nanaimo - Members and Friends Print Application

You can join as a member or a friend without giving your name; however you must provide an alias (user names, first and last) and a contact email address. You can get an anonymous email address from gmail.com.

Information about you:

User Name: (First ) ____________________________ (Last) _____________________________

Email Address: ________________________________ Birthdate: __________________________

City of Legal Residence: _________________________ Telephone (optional): _________________

Information about your partner (if you are part of a couple):

User Name: (First) _____________________________(Last) ______________________________

Email Address: ________________________________ Birthdate: __________________________

City of Legal Residence: _________________________ Telephone (optional): _________________

Application Type

This is an application for (check one):

Single Membership ___ ($25.00 annually)	..........	Single Friendship ___ (free)

Couples Membership ___ ($50.00 annually)		Couples Friendship ___ (free)

Privacy Policy

In applying for membership or friendship, you (or you both, if a couple) agree not to use any email or personal information you acquire about other members or friends for other than chapter business - unless you obtain prior permission from the member or friend to do so. The chapter also makes a privacy commitment to you not to use personal information collected about you for other than chapter business. Full details of this policy are at Code of Conduct and Privacy Policy.

Access to Other Members and Friends

For privacy reasons, the Chapter does not publish a Membership / Friendship List. However, if you wish to personally contact a member or friend, these means are available:

request the phone number or email directly from the member or friend at any event,
request the phone number or email from the secretary at This email address is being protected from spambots. You need JavaScript enabled to view it. who will pass on the request to the intended recipient. If he agrees, the Secretary will pass the contact information on to you; if not, the Secretary will let you know the request has been denied.

Remember that the agreed privacy policy still applies to contact information obtained by either means.

Code of Conduct

In applying for membership or friendship, you agree:

to treat other friends and members with respect and
not take action which would disrupt events sponsored by the chapter, other Prime Timers chapters or Prime Timers World Wide and
to not take action which would cause distress to other members or friends, members or friends of other Prime Timers chapter or independent members of Prime Timers World Wide and
that majority vote of the Board of Directors will be the sole determinant of violation of this Code of Conduct and
and that, if the Board determines that you have violated this Code of Conduct, the Board may, by majority vote, revoke your membership or friendship.

_______________________________________ _______________________________________
Your Signature Your Partner’s Signature (if a couple)

Submission

You can print and complete this form and mail it to the Chapter address:

PRIME TIMERS NANAIMO
P.O. Box 278
Ladysmith, BC
V9G 1A2

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Or, you can print and complete this form and bring it to any pub night or coffee morning or any other chapter sponsored event.

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Or you can copy the form into an email message, complete the form and send it to This email address is being protected from spambots. You need JavaScript enabled to view it.
using your listed email as confirmation of your acceptance of both the privacy policy and code of conduct.