*Are you applying today as a new member? _____ Yes _____ No
*First Name ________________ MI ____ *Last Name ___________________________
*Address________________________________________________________________
Address________________________________________________________________
*City_________________________________ *State ________ *Zip _________-______
*Primary Phone ___________________ Alternate Phone (optional) __________________
Email __________________________________________________________________
(An email address is preferred for best communication.)
Spouse's name (optional) ________________________________________________
*Which Alaska retirement system did you retire under? (Enter all that apply.)
-- PERS, TRS, JRS, NGNMRS, EPORS or NONE for Associate Member ______________________
*Dues: 1 year - $35 | 2 years - $65 | 5 years - $145 | Lifetime member - $400
(Circle one)
Print and mail this completed application, with dues, to
RPEA
PO Box 110650
Anchorage, AK 99511-0650
NOTE: Membership dues or any other contributions to RPEA are not deductible for federal income tax purposes as charitable donations.