New Mexico Association of Educational Retirees

MEMBERSHIP FORM

Instructions:

     First:     Please fill out the member information box below

     Second: Select your payment option below and follow the instructions for that option

MEMBER INFORMATION            PLEASE PRINT

Name:__________________________________

Address:________________________________

_______________________________________

City:____________________________________

State:__________                      ZIP____________

___Payment Option #1:

Enclose a check or money order for $25

Make it payable to:  NMAER

         Please Print and Return this form with your payment to:       

                 NMAER

                 3900 Juan Tabo NE   Suite #9

                 Albuquerque, NM 87111   

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____Payment Option #2:      Please deduct my $25 dues payment from

                                                    Monthly retirement distribution unless and

                                                    Until I notify ERB in writing to cancel this deduction

            _______________________                                         ____________

                 (Member Signature) *                                                           (Date)*  

                                    I      I     I      I ---I__  I      I      I      I---I     I      I     I

                                                      Social Security Number *                                                                             

* = Required for this option

Mail this completed form to:        NMAER

                                                3900 Juan Tabo NE   Suite #9

                                                Albuquerque, NM  87111

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

 ASSOCIATE MEMBERSHIP

___Payment Option #3:

Enclose a check or money order for $5

Make it payable to:  NMAER

         Please Print and Return this form with your payment to:       

                 NMAER

                 3900 Juan Tabo NE   Suite #9

                 Albuquerque, NM 87111   

PLEASE PRINT

Name:__________________________________

Address:________________________________

_______________________________________

City:____________________________________

State:__________                      ZIP____________