Social Security Alumni Association Membership Form

Please complete this form and mail it to SSAA with your annual dues of $10.00. Your membership also entitles your spouse to membership

Check One:
New Member (Retired):______
New Member (Still Employed):_______

Member’s Name (Please print or type)

Address (Street) P.O Box or Apt. No.

City State and Ten-Digit Zip Code

Telephone (Area code & number)

Name of Spouse

E-mail Address (OPTIONAL)

(Answer "YES" or "NO " for each) Do you want the Directory to list your:

Name?__________ Address?__________ Telephone?__________

Signature

Date

Please send your $10.00 check or money order (no cash) along with your application to:

In the interest of economy, the OASIS has requested that we help to reduce the number of copies distributed. Please express your interest by answering the question below.

Do you want to receive the OASIS when it becomes available? Yes____ No____