Wisconsin Education Association Council-Retired

PRE-RETIRED SCUBSCRIBER ENROLLMENT FORM
(Print this form, complete it and return by mail.)

Pre-Retired Subscriber Enrollment (prepaid life membership) costs $375, which includes WEAC-Retired/NEA-Retired dues.

(Neither WEAC nor NEA life active membership, discontinued in 1972, includes retired membership.)

Employer/School District Retired From: ___________________________

Name (last, first, middle initial): __________________________________

Street Address: _____________________________________________

City, State, Zip Code: ________________________________________

Area Code/Home Phone # _____________________________________

E-mail address: _____________________________________________

Signature __________________________________________________

Date _____________________________________________________

Total Dues Amount Remitted ___________________________________

(Concurrent membership in NEA-Retired is required and included in the dues cost. )

Return completed form and dues money to:

WEAC-Retired Membership
P.O. Box 45407
Madison, WI 53744-5407

Please print/type. Make copy for your records.