CSRS Senior Membership Request Form

CSRS Senior Membership Request Form
Active members wishing to transition to senior status must confirm that they are either 65 years old or are no longer seeing clinical patients or receiving employment from outside sources. Senior members’ status may be conferred at the discretion of the Board of Directors on those individuals who request such a change.

Each Senior Member has a right to vote but does not have the right to hold office. Senior Members are not required to pay annual dues or to submit papers for presentation, but shall pay expenses for meetings attended on a pro rata basis.

Changes in membership will be reflected in the 2026 dues cycle beginning January 1, 2026.
Name of Active Member requesting Senior Status*

First NameLast Name
Email Address*
Please confirm that you are either 65 years old or are no longer seeing clinical patients or receiving employment from outside sources*

YesIf the answer is no, you will not be eligible for senior membership status this year.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upon submitting this form, your request will be sent to the Membership Committee and Board of Directors for review.
Should be Empty: