Application

Application accepted from men age 21 and over. Please fill out and return entire form.
 

Membership fees: Individual: $35.00 — Couple: $70.00
For a printed copy of the Newsletter, we charge $15 annually.
Your Application will only be processed, after the payment is received.

 

Or per Credit Card:
Single | Couple

Or, pay in cash at the Tuesday Mixers or on the Monthly Meetings.

Make check payable to:
Ft Lauderdale Prime Gentlemen, Inc.
And mail it to:
PO Box 100666, Ft. Lauderdale, FL 33310

    1st Partner

      .

      .

    .

    2nd Partner

      .

      .

    .

    Address

      .

    .

    Second Home Address

      .

    .

    Couples Only

      If you would like to have your anniversary recognized in the newsletter, please enter date.

    .

    In case of an emergency, please provide a contact
    Interest Profile
      AntiquesBicyclingBowlingBeach/SunbatheBridgeBoatingCard GamesCookingConcertsCompanionshipCruise ShipsComputersDining OutDancing
      EroticaFlea markets/yard salesGardeningGay BarsGolfHouse Parties/Pot LuckSeeking LTRGym PartnerMassageMovies at theaterMovies at homeMusic/listenMusic/playMuseums
      NudismPhotographyReading/DiscussionRunning/joggingRV - Motor Home/RVSingingSkiingSpectator SportsSwimmingSexual EventsTheaterTennisTravelWalking
    Volunteer to Help
      Serve as an OfficerHost a party in my home
      Serve as a Committee ChairCo-Host a party someone else home
      Work on a committeeWilling to host an out-of-town Prime Gentlemen in home

    .

    Roster Publication Preferences
      Do you wish to have your name, address, and interest profile published in the Membership Roster? (required)

      YesNo

      Members who are not published in the Membership Roster will not receive a copy of the Roster.

      .

      I agree NOT to share the roster data with non-members under any circumstances as specified in Prime Gentlemen Policies & Procedures.

    .

    Signature

      By signing below, I certify all information is true and correct to the best of my knowledge.

      .

    .