Wild Apricot MEMBER APPLICATION

MUNICIPAL PENSION RETIREES' ASSOCIATION

Effective January 1, 2022 annual dues shall be $22.00 per member and $40.00 per couple. *New members who receive a municipal pension (MPP) will be offered a free membership for the calendar year in which they apply. These members must provide their PID number for automatic Dues Deduction in subsequent years.

MPRA Office Phone number for inquiries: 250-768-1519 Website: www.mpra.ca

Please choose your Membership Level: *

MPP Individual Retiree - An individual member who is receiving their own Municipal Pension $22.00 Free for the first calendar year MPP Member and Partner - Member with a partner who is not receiving their own Municipal Pension $40.00 per couple - Free for first calendar year Associate Individual Retiree (non-voting) - Including members collecting LTD and other Pension Plans $22.00. Please pay via mailed cheque or E-transfer to accounting@mpra.ca Associate Member and Partner (non-voting) - including members collecting LTD and other Pension Plans $40.00. per couple. Please pay via mailed cheque or E-transfer to accounting@mpra.ca

First Name (Please identify your legal name as it appears on your pension documentation *

Middle Name (Please identify your legal name as it appears on your pension documentation

Last Name (Please identify your legal name as it appears on your pension documentation *

Partners Last Name *

Partners First Name *

Partners Middle Name

Address *

Address

Street Address Line 2

City

Province/Other *

Postal Code *

Please select the district that you wish to attend meetings. *

Primary Phone *

Secondary Phone

Email Address

example@example.com

Previous Employer *

Pension Effective Date: *

Date

Birth date:

Date

How did you hear about the MPRA?

The personal information provided to the Municipal Pension Retirees' Association (MPRA) including the Person ID number will be kept confidential and will only be used for MPRA membership purposes. I give consent to the MPRA to exchange my personal information when making inquiries on my behalf to the BC Pension Corporation. The MPRA is not affiliated with the Pension Corporation or the Municipal Pension Board of Trustees. Annual dues will be deducted from the March Municipal pension payment each year until such time as I revoke this authorization in writing or email to the MPRA.

Your PID # is your Person Identification Number. Insert your PID # Here:

This is an requirement of the Pension Corporation for all Municipal Retirees'. If you are collecting long term disability (LTD) your PID number is not required, please sign up as an associate member. (PID # can be found on your pension statement and is also located on your Pacific Blue Cross Card if enrolled)

I understand that my annual dues will be deducted from my march Municipal Pension Payment until such time that I revoke this authorization in writing or email to the MPRA office.

Currently, the Pension Corporation requires a written signature identifying consent. Please sign and date.

Signature

Clear

Date:

Date

MEMBER APPLICATION FORM