Membership Renewal Form

RETIREE/EMPLOYEE:

ENTER THE INFORMATION BELOW IF IT HAS CHANGED

SPOUSE/PARTNER:

Primary Address:

Street Address:

Street Address Line 2:

City, State, Zip Code:

Seasonal Address:

Seasonal Street Address

Seasonal City, State, Zip Code:

Dates of seasonal address:

Email (Retiree):

Phone number:

Email (Spouse/Partner):

Alternate phone number:

How do you want to receive the newsletter?

Emailed newsletter

Printed newsletter

Information for the newsletter

COMPLETE THE FOLLOWING AND CLICK ON "SUBMIT RENEWAL"

Membership renewal is $10 per year

Number of years to renew or extend

If you have an email account you will receive a Membership Directory by e-mail.

Check here if you do not have an email account and want a printed copy of the Membership Directory at $12.00 per copy.

Optional donation (tax-deductible)

Enter the total amount you wish to pay:

DNR, DEQ, & EGLE Retirees Association