Membership Form

Name:________________________

Social Security #________________

Address:______________________

City:__________________________

State:________________________

County:_______________________

Zip Code:_____________________

Phone#:______________________

E-Mail:_______________________

Birthday:____________________________

Would you like to receive a reminder call  before each meeting?  _____YES   _____NO

I hereby authorize the Educational Retirement Board to deduct NMAER state dues from my retirement check in the amount of $2.08 a month.  I understand this authorization makes me a continuing member of the association and can be canceled only by a written notice from me.

______Already on automatic state dues

______$25.00 enclosed for annual state dues

______$10.00 enclosed for annual local dues

_____________________________________

      (Signature of Retiree)

Date:_______________________________

Make Checks Payable to SJAER

Mail to Membership Chair, Karen Ransom   900 Hare Street, Bloomfield, NM  87413-5206

Dues are not Tax Deductible

Sponsored by Karen Ransom

Unit Sponsored by      San Juan AER

Membership Form

Name:________________________

Social Security #________________

Address:______________________

City:__________________________

State:________________________

County:_______________________

Zip Code:______________________

Phone#:______________________

E-Mail:_______________________

Birthday:____________________________

Would you like to receive a reminder call  before each meeting?  _____YES   _____NO

I hereby authorize the Educational Retirement Board to deduct NMAER state dues from my retirement check in the amount of $2.08 a month.  I understand this authorization makes me a continuing member of the association and can be canceled only by a written notice from me.

______Already on automatic state dues

______$25.00 enclosed for annual state dues

______$10.00 enclosed for annual local dues

_____________________________________

      (Signature of Retiree)

Date:_______________________________

Make Checks Payable to SJAER

Mail to Membership Chair, Karen Ransom   900 Hare Street, Bloomfield, NM  87413-5206

Dues are not Tax Deductible

Sponsored by Karen Ransom

Unit Sponsored by      San Juan AER

Membership Form

Name:________________________

Social Security #_______________

Address:______________________

City:__________________________

State:________________________

County:_______________________

Zip Code:______________________

Phone#:______________________

E-Mail:_______________________

Birthday:____________________________

Would you like to receive a reminder call  before each meeting?  _____YES   _____NO

I hereby authorize the Educational Retirement Board to deduct NMAER state dues from my retirement check in the amount of $2.08 a month.  I understand this authorization makes me a continuing member of the association and can be canceled only by a written notice from me.

______Already on automatic state dues

______$25.00 enclosed for annual state dues

______$10.00 enclosed for annual local dues

_____________________________________

      (Signature of Retiree)

Date:_______________________________

Make Checks Payable to SJAER

Mail to Membership Chair, Karen Ransom   900 Hare Street, Bloomfield, NM  87413-5206

Dues are not Tax Deductible

Sponsored by Karen Ransom

Unit Sponsored by      San Juan AER