Membership - New and Renewal - RIPEA - Retired Indiana Public Employees Association

RIPEA New Membership and Membership Renewal Form

Annual dues are for January through December of each year. As a gift to you we are offering a special price of $18 to pay for the rest of this year and all of next year!

Required fields are marked (*)

New or renewing membership?(*)

New Member (Dues Expire 12-31-2021)Renewal (Dues Expire 12-31-2021) Please select whether this is a new membership or renewal.

Referring Member's Name

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RIPEA ID#

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Member's First Name(*)

Please type your first name.

Member's Last Name(*)

Please type your last name.

Date of Birth(*)

/ / Please enter your date of birth

Name of Spouse

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Telephone(*)

Be sure to include your area code.

Street Address(*)

Please enter your street address.

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

YesNo Please select Yes or No

Street Address 2

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City(*)

Please enter the city

State(*)

Please enter two-digit state code

Zip Code(*)

Please enter valid US Zip Code

E-mail(*)

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

Please type your full name.

Member Dues
(Dues Expire 12-31-2021)(*)

Active Member - One Time Payment (SPECIAL $15 OFFER, MEMBERSHIP TERM ALSO EXTENDED THROUGH 12/31/2020) - $15.00 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 Please select membership type.

Add my spouse to the RIPEA membership?(*)

Yes - $10.00 USDNo Please select spousal membership option.

Name of Spouse(*)

Please enter name of spouse.

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

Please also consider including a recurring 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)

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Total

$0.00 USD

Consent(*)

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

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.

RIPEA New Membership and Membership Renewal Form

Benefits of Your RIPEA Membership