Retired Membership

NEA-New Mexico Retired Membership Application Form
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile/Home Phone*
Personal E-mail
example@example.com
Date of Birth*

MonthDayYear
Date
Ethnicity

American Indian/Alaska NativeNative Hawaiian/Pacific IslanderHispanicAsainBlackWhiteMultiple RacesOther
Gender

FemaleMaleTransgender FemaleTransgender MaleGender Expansive/Non-ConformingOther
Total Dues. If you are interested in a monthly payment— please call us.*
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Former Certified Retired AnnualNEA Dues- $35 NEA-NM Dues- $25
$60.00



Former Certified Retired LifeNEA Dues- $300 NEA-NM Dues- $200
$500.00



Certified Pre-Retired LifeNEA Dues- $300 NEA-NM Dues- $200
$500.00



Former ESP/Classified Retired AnnualNEA Dues- $21 NEA-NM Dues- $15
$36.00



Former ESP/Classified Retired LifeNEA Dues- $180 NEA-NM Dues- $120
$300.00



ESP/Classified Pre-Retired LifeNEA Dues- $180 NEA-NM Dues- $120
$300.00



Foundation for the Improvement of EducationOptional Contribution
$10.00 Quantity



EdPACOptional Contributions
$10.00 Quantity



Total

$0.00
Signature*

Clear
Your e-signature is a verification that you have read and agreed to NEA-NM terms mentioned above.
Today's Date

MonthDayYear
Date
I hereby agree to pay cash (membership does not become effective until payment is recieved), by credit card, or authorize the Educational Retirement Board to deduct dues from my monthly retirement payment.

If you are paying by cash or monthly deductions, please print form once signed and mail to:

NEA-NM Membership Processing

2007 Botulph Road

Santa Fe, NM 87505

I UNDERSTAND THAT THIS AGREEMENT IS VOLUNTARY AND IS NOT A CONDITION OF EMPLOYMENT AND THAT I HAVE THE LEGAL RIGHT TO REFUSE TO SIGN THIS AGREEMENT WITHOUT SUFFERING ANY REPRISAL.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

NEA-New Mexico Retired Membership Application Form