Membership Application
To apply for membership please complete all questions.
Name
First Name
Last Name
Affiliation with United
*
Please Select
Employee
Retiree
Widow/Widower
E-mail
example@example.com
Phone Number
*
Format: (000) 000-0000.
Employee File Number
*
Last Duty Station Code
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Monthly Membership
Monthly Membership for United Retired
$5.00
$
5.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Apply for Membership
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