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MEMBERSHIP FORM

WASHINGTON STATE SCHOOL RETIREES’ ASSOCIATION

PO BOX 5127, LACEY, WA 98509

WSSRA Credit or Debit Card payment for $84 annual dues with Auto Renew

First Name

Middle Name

Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Personal Email

example@example.com

Verify Email *

SS Number

Please select your Unit.

Retirement Date

(Month and Year)

Retirement Plans

School District (where last employed)

How did you hear about us?

WSSRA ( $ 84.00 for each year )

Membership Dues

Email