Retiree Membership Application | Retired Public Employees Council of WA

Membership Option (please select an option)

New Membership
Dues Renewal (for cash members only)

Name

First

Last

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Address

Address Line 1

City

State

Zip Code

Mailing Address (If different)

Address Line 1

City

State

Zip Code

Email

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Home Phone

Cell Phone

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Retirement Plan

Agency Retired From

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Retirement Date

Birth Date

Select Membership Option

Retiree or Surviving Spouse ($7/mo)
Retiree & Spouse/Partner ($14/mo)

Spouse/Partner Name (If Selecting Retiree & Spouse/Partner Option)

First

Last

Dues Payment Method

Automatic Dues Deduction via DRS Pension
Credit Card (recurring charge)

Sign Here to Authorize Automatic Deduction via DRS Pension

Clear Signature

I authorize the Department of Retirement Systems (DRS) to regularly deduct a sufficient amount from my retirement allowance to pay the amount required for my union/organization dues at my request, under this program. Deductions will continue until the deduction plan is canceled through the union/organization office. I understand that DRS cannot answer questions about my union or organization. RPEC is 501c5 organization. Dues are not tax deductible.

Authorization

I have read the above statement and agree to its terms.

Dropdown Items

Total Charge

$0.00

Note: Total charge includes a $2.00 service fee for credit card processing.

Credit Card Payment

Card Number

Expiration

/

Security Code

I authorize the Retired Public Employees Council of Washington (RPEC) to charge to the credit card entered above, the amount required for my membership dues + service fee ($2.00), as indicated by my selection. RPEC is 501c5 organization. Dues are not tax deductible.