MEMBERSHIP APPLICATION

Membership Application

Memberships expire on December 31 each year.
Pittsburg Fifty Plus Club Corporation
- PO Box 1871, Pittsburg CA 94565
- www.pittsburgfiftyplusclub.com
- (925)439-2135 voicemail only
- Email: pitt50plus@gmail.com
Yearly Membership dues: $25/person starting January 2023

Membership is Not Transferable and Dues are Not Refundable

INSTRUCTIONS: (1) Each person must submit their own individual form. *Required fields (2) Make a copy for your records. (3) Submit the form and remit payment by mail or electronic transmission (see below).

NEW!! Check Membership Status and update your information here!!!
First Name*
Middle Name
Last Name*
Suffix
Birth Date*

MonthDayYear
Preferred Name
After user enters data, this area wil be used to calculate membership status (GOOD, LTM, DEC, UNPAID) and then ask what to do next.
1. Calculate UK: substrings
2. Upload current membership database (CMDB)
IF UK is in CMDB, then active member.
- show status and expiration date if applicable
- show current data on file & allow updates
- go to payment page
- flags: update only
Else, inactive or new member.
- allow new data entry
- go to payment page
Membership Status [STATUS]:
- BLANK: no data on user
- UNPAID: member has not paid dues
- GOOD: member in good standing; show expiration date or LTM
- DEC: member is deceased
DATA ENTRY/VERIFICATION (all users):
1. if Membership Status is GOOD
  - UPDATE flag: set depending on user input
  - RENEW flag: set depending on user input
2. give instructions for data entry
3. show data on file (blank if none)
4. verify data
5. go to payment page
STATUS
Expiration Year
Deceased
Membership Status
Mailing Address*
Street Address or PO Box (include apartment #)
City State Zip*
Select one combination or choose OTHER to type another.
OTHER City State Zip

CityState

Zip Code
Phone*
Email

Confirmation Emailexample@example.com
Next of Kin First Name*
Next of Kin Last Name*
Next of Kin Phone

Select Payment Method Below: Membership will be effective once payment has been processed. Please check back at this link for Membership Status.*

ZelleCashCheckSquareI am only updating my informationMembership Database information is correct. No changes.
INSTRUCTIONS FOR REMITTING FUNDS THROUGH ZELLE
1. If your bank supports Zelle, log in to your bank account. If your bank does not support Zelle, download and install the Zelle app to your tablet or phone.
2. From the bank menu, select Zelle or QuickPay with Zelle.
3. Click on Send Money in the drop down menu.
4. Recipient: Pittsburg Fifty Plus Club. If necessary, add Pittsburg Fifty Plus Club to your list of recipients (see below).
5. Enter amount of your payment. $25 after January 31, 2023.
6. Memo: Name(s) of membership applicant(s).
7. Click Send money button. Follow additional prompts to confirm funds transfer.
Adding Pittsburg Fifty Plus Club to your list of Zelle recipients:
1. Click on Add recipient
2. In the Name field, type Pittsburg Fifty Plus Club.
3. In the Email field, type pitt50plus@gmail.com
4. Click on ADD RECIPIENT.
CASH PAYMENT

Please call (925) 439-2135 to make an appointment to pay in person.
PAYMENT BY CHECK

Make payable to Pittsburg Fifty Plus Club.

Mail to:
- Pittsburg Fifty Plus Club
- PO Box 1871
- Pittsburg CA 94565
There is a $20 returned check charge.

Update Data
TERMS OF ACCEPTANCE & AGREEMENT

I, the applicant, accept and agree with the following statements:
1. To the best of my knowledge, the information provided in this application is true and correct.
2. This application is for membership in the Pittsburg Fifty Plus Club Corporation in Pittsburg, California, USA.
3. I am or will be at least 50 years old during this current year.
4. Annual Membership Dues: $25 (USD) per person. Membership will be effective when payment is received.
5. Membership expires December 31 each year. Dues are not prorated.
6. Membership is not transferable and and dues are not refundable.
7. I may request a copy of the By-Laws by sending an email to pitt50plus@gmail.com, SUBJECT:BY-LAWS.
Should be Empty:

Membership Application

Credit Card