RPEA Membership Application


(* - required field)

*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.