Retiree Membership Application | Retired Public Employees Council of WA

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New Membership
Existing Member Dues Renewal (Cash only)

Name

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Last

Address

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Mailing Address (If different)

Address Line 1

City

State

Zip Code

Email

Home Phone

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Retirement Plan

Agency Retired From

Retirement Date

Recruited By

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Dues Payment Method

Automatic Dues Deduction via DRS Pension
Credit Card

Select Membership Option

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

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

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Last

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.

Membership Option:

Dues are charged at an annual amount of $84 for retiree or surviving spouse, and $168 for retiree & spouse/partner.

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

First

Last

Total to be Charged:

Item Quantity Total

There are no products selected.

Membership Option: – Annual Dues (Retiree Only) 1 $84.00

Membership Option: – Annual Dues (Retiree & Spouse/Partner) 1 $168.00

Total $84.00

Credit Card Payment via Square

Card

Name on Card

By clicking on the Submit button below, I authorize the Retired Public Employees Council of Washington (RPEC) to charge the credit card entered above, the amount required for my membership dues, as indicated by my selection. RPEC is a 501c5 organization and dues are not tax deductible.