University of Wisconsin Retirement Association

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MEMBERSHIP APPLICATION

Membership is $20 and covers through 8/31/09. $40 extends your membership to 8/31/10. Out of Area Memberships are $10/$20 respectively. Note that a spouse/partner may be included in the annual fee – they need not ever have worked for the UW.

Name(s):

Application for:
New Membership (One Year/$20)
New Membership (Two Years/$40)
Renewal Membership (One Year/$20)
Renewal Membership (Two Years/$40)
Out of Area New Membership (One Year/$10)
Out of Area New Membership (Two Years/$20)
Out of Area Renewal Membership (One Year/$10)
Out of Area Renewal Membership (Two Years/$20)

Email Sifter (sent in PDF format; automatic with Out of Area membership)

Phone: ( ) - Email:

Street:

City State Zip+4 -

My/our department(s)/unit(s) at UW-Madison:

I am:
Current employee Retired

I am/was:
Faculty Academic Staff Classified Staff

Topics I/we would like to see in Association programming:

Association activities for which I/we would like to offer my/our expertise:

Select one of the following payment methods.

I am paying with an electronic transfer from the UW Credit Union.
(NOTE: This is a two part process. You must submit this form and pay online in order to complete your application. The link to the online payment will appear on your confirmation screen, and confirmation email.)

I am sending a check for $20 (or $40 for two years) made payable to the UW-Madison Retirement Association. Print this form or confirmation screen and send check to address below.

I am sending a check for $10 (or $20 for two years) made payable to the UW-Madison Retirement Association. My Zip Code is other than 535xx, 537xx, or 539xx. Print this form or confirmation screen and send check to address below.

UW-Madison Retirement Association
c/o UW Foundation
P.O. Box 8860
Madison, WI 53708-8860