JotForm New Membership

New Membership
Membership in Bears of the Old Pueblo is open to anyone 18 years of age or older. An online membership form is available below.

Full Membership - $25/year
Your Information and Preferences
Full Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail:*
We use your email address to send you email from the BOTOP members mail list which is used to provide notices of events and business of the organization. Your email address is not revealed in any email sent from the mail list and is not provided to any outside party.
Add me to the mail list:*

YesNo
Phone Number:

Area CodePhone Number
Mobile Phone Number:

Area CodePhone Number
NOTE: We do not record or disclose the year of your birth. Only the day and month are maintained in our records.
Birth Date:*

MonthDayYear
Are you 18 years or older?*

YesNo
I give Bears of the Old Pueblo permission to include the following information in the members-only membership directory:
Check all that apply:*

Please do not include any of my information.NameAddressPhoneEmailBirthday
By checking below I certify that I am at least 18 years of age and wish to join Bears of the Old Pueblo. I understand that this is a social organization for gay and bisexual men and their admirers.
Do you accept?*

YesNo
Please tell us how you plan to pay your dues*

Check or money order made payable to BOTOP and mail to 3938 E Grant Road #193, Tucson AZ 85712PayPal - this option presented on next page after Submit
Should be Empty:

New Membership

Your Information and Preferences