QC Singles Online Membership Form
Want to renew your membership
If you are already a current Quad City Singles member and want to renew your membership please complete the renewal form.

-- download the renewal form
To join Quad City Singles, please complete and submit the following membership form. After completing the membership, mail your membership fee of $30 to the following address:

Quad City Singles, Inc.
P.O. Box 776 East Moline, IL 61244

 

First Name
 Last Name
Address
 City
State
 Zip Code
Phone
 Cell Phone
E-Mail
Sex
 Birth Month

Are you widowed, legally divorced, or never married?
Are you age 40 or above?

What other events and/or suggestions would you like to see offered from Single events?

A directory of club members is published annually with quarterly updates provided as appropriate.  The directory is used for club business only and the sale or other use is expressly forbidden without the specific written approval of the Board of Directors. 
Include my name and telephone number in the Club Directory and/or updates to the directory. My signature below absolves Quad City Singles, Inc. of responsibility for any misuse by members or nonmembers of the published directory.  Once my name appears in the directory I may rescind this approval in writing for removal of my name from future publications only.
Do not include my name and telephone number in the annual directory or any of its updates.

How did you learn about Quad City Singles 40 Plus? (Check all that apply)
Newspaper Ad Newspaper Article Word of Mouth
Television Feature Television Ad Other

By clicking "Submit Form" I certify that all information furnished on this Membership Application is true and accurate. I agree to abide by the Bylaws and Policies in effect now and in the future as established by the Board of Directors of Quad City Singles, Inc. and understand that failure to comply will result in expulsion from the group without recourse. Quad City Singles, Inc. (aka Quad City Singles 40 Plus), its agents or assigns, has my permission to use my name, my comments and photographs of me for advertising or publicity in any or all of the following media or formats: still, motion picture, video, television and/or in another media or format, electronic or otherwise, as currently exists or which becomes available in the future. View current Bylaws and Policies.

Quad City Singles, Inc. (aka Quad City Singles 40 Plus), its agents or assigns, has my permission to use my first name with the first initial of my last name and photographs of me for advertising or publicity in any or all of the following media or formats:  still, motion picture, video, television and/or in other media or format, electronic or otherwise as currently exists or which becomes available in the future. The Photo policy is available on the Quad City Singles Policies webpage.