RIPEA New Membership and Membership Renewal Form

Required fields are marked *

New or renewing membership?*

New Member (Dues Expire 12-31-2024)

Renewal (Dues Expire 12-31-2024)

Member's First Name*

Member's Last Name*

Street Address 1*

Street Address 2

Would you like to receive your Communicator newsletter by email?*

Yes

Your Name (if paying for spouse, parent, or another Member)

Member Dues* (Dues Expire 12-31-2024)

Active Member - One Time Payment (MEMBERSHIP TERM ALSO EXTENDED THROUGH 12/31/2024) - $18.00 USD

Retiree Member - One Time Payment - $18.00 USD

Active Member - Set Up Recurring Payments - $15.00 USD

Retiree Member - Set Up Recurring Payments - $15.00 USD

Associate Member - One Time Payment - $10.00 USD

Associate Member - Set Up Recurring Payments - $10.00 USD

Add my spouse to the RIPEA membership?

Yes - $10.00 USD

Please also consider including a gift to the RIPEA Foundation. Donations to the RIPEA Foundation are tax deductible to the fullest extent allowed by law.

Gift to RIPEA Foundation (Optional)

I give RIPEA permission to collect, process, store and use the personal information given on this form.

I provide permission for the RIPEA Insurance Trust to be notified of my participation in a benefit or program through AMBA or its partners. I may revoke this authorization in writing at any time. The information to be disclosed is only my name and the fact that I have elected to participate. Full privacy notice can be found at ripea.org/privacy.

RIPEA uses PayPal to process our online payments. When you use PayPal, your financial information is not shared with us.
Once your payment is complete, PayPal will send a receipt for this transaction to the email address used when you check out at PayPal.