Already a member looking to renew your membership? If you are already a Quad City Singles member and want to renew your membership please download and complete the membership renewal form.
 
Quad City Singles New Member Form
To join the Quad City Singles 40 Plus, please complete and submit the following membership form. After submitting your information, mail your membership fee of $24 to: Quad City Singles, Inc. P.O. Box 776 East Moline, IL 61244

First Name
(required)
Last Name
(required)
Sex
(required)
Birth Month 
(required)

Phone
(required)
Cell Phone

Email Address
(required)

Address
(required)
City
(required)
State
(required)
Zip
(required)

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

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.





By clicking "Submit to Join QC Singles" 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.