PTSC  Prime Time Single Catholics

                                           2024 NEW AND RENEWAL MEMBERSHIP APPLICATION
                                     PRIME TIME SINGLE CATHOLICS (PTSC) OF NORTHERN VIRGINIA

PLEASE TYPE OR PRINT CLEARLY 

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APPLICATION TYPE: ____ NEW ____ RENEWAL
NAME:__________________________________________________________________________
               (LAST)                                                      (FIRST)                        (MIDDLE INITIAL)

BIRTHDAY (MONTH & DAY) (OPTIONAL) ___________________________
ADDRESS:__________________________________________________________________________

                      (NUMBER, STREET, APARTMENT NUMBER)
__________________________________________________________________________
                       (CITY STATE  9-DIGIT ZIP CODE (ZIP + 4))

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HOW SHOULD YOUR NAME APPEAR IN THE DIRECTORY? ___________________________________________
PHONE/E-MAIL: (PUBLISH = PUBLISHED IN PTSC DIRECTORY OR RELEASED TO OTHER MEMBERS)
PRIMARY PHONE #: (_____)____________________________ PUBLISH PHONE #? YES ____ NO ____
E-MAIL: ___________________________________________      PUBLISH E-MAIL?    YES ____ NO ____
PARISH: _______________________________________________________
EMERGENCY CONTACT:
NAME: ______________________________

PHONE #(s): ______________________________________________________

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HOW DID YOU HEAR ABOUT PTSC? ______________________________________________________________________

MEMBERSHIP REQUIREMENT: I am a single Catholic, 40 years of age or older, who is free to marry in the Catholic Church because I am either single, widowed or, if divorced, have an annulment. I agree to abide by such rules and regulations as stated in the Bylaws of Prime Time Single Catholics (PTSC) of Northern Virginia and/or as adopted by the Executive Council. Membership may be revoked or suspended in accordance with the PTSC Bylaws. I waive and release any claim or cause of action that I may have against PTSC, its officers or directors, and/or its members for any damages, injuries, or losses sustained by me while participating in events and functions sponsored by the PTSC, except when caused by gross negligence or willful misconduct on the part of the PTSC, or its officers and directors.
I certify that I meet the above membership requirements and hereby apply for membership. (NOT VALID UNLESS SIGNED)
          __________________________________________________________________ _____________________
                                    SIGNATURE (Required)                                                                     DATE

_____________________________________________________________________________________________________

PLEASE MARK (X) IF WILLING TO ASSIST US AT AN EVENT IN ANY OF THE FOLLOWING AREAS:
_____COMMUNITY SERVICES _____CULTURAL _____DANCES _____HOSPITALITY _____MEMBERSHIP
_____NEWSLETTER/EDITORIAL _____PARISH REP _____PUBLICITY _____RECREATION _____RELIGIOUS   _____ROVING RESTAURANTEERS _____SOCIAL
_________________________________________________________________________________________________________

MEMBERSHIP DUES: For current or recent (2021-23) members: $27. For everyone else: If we receive your application in Jan.-Feb., $27; Mar.-May, $20; June-Aug., $14; and Sep.-Oct., $7. For everyone: If we receive your application in Nov. or Dec. 2024: $27, credited as full payment of dues for 2024 and 2025.

 

PLEASE MAKE CHECK PAYABLE TO “PTSC” AND MAIL WITH THIS FORM TO:

PTSC MEMBERSHIP CHAIRPERSON

(For the mailing address, please email ptscnva@gmail.com.)

 

___________________________________________________________________________________________________________

FOR MEMBERSHIP CHAIRPERSON ONLY: AMOUNT PAID: ________ CHECK NUMBER/DATE: _______ / __________ DATE RECEIVED: __________ INITIAL: _____                                                                                                   [updated 12/2/2022]