Already retired membership form

Already retired membership form

To join, print out the enrollment form below, complete the requested information, and mail it with check/money order, made payable to WEAC-Retired (please do not send cash), to: WEAC-Retired Membership, P.O. Box 45407, Madison, WI 53744-5407.

Last Name ___________________ First Name _______________ Initial ____

Street Address _________________________________________________

City __________________ State _______________ Zip ________________

Area Code/ Home Telephone # __________________

E-mail Address ______________________________

Local Association retired from _____________________________________

Retirement Date ___________________________

Signature __________________________________Date ______________

I have enclosed a check/money order for: (check one below)

WEAC/NEA-Retired Annual dues ($65)

WEAC/NEA-Retired Life Membership ($375)

Total dues amount remitted: ______________________________________