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RFSA Membership Form

Applicant Information

Name of Retiree:
Nametag Name:
Year of Retirement:
Spouse/Significant Other Name:
Nametag Name:
  I am a surviving spouse of a retiree

Annual Membership Dues

$25.00 - Individual Membership
$35.00 - Joint Membership
$70.00 - 3-year Individual Membership (save $5)
$86.00 - 3-year Joint Membership (save $10)
"I would like to make a donation to the RFSA Scholarship Fund"   $.00

Interest Groups and Publications

Please place my/our names on the mailing list for the following interest groups:
Bridge Group Discussion Group Travel Group
Exercise Group Finance/Investment Group Fine Arts Group
Health Group    



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