Social Security Alumni Association
Membership Renewal Form

Name (please Print of Type)

Name of Spouse

Please send your $10.00 yearly dues (check or money order) made payable to "Treasurer, SSAA" along with this renewal form to:

Social Security Alumni Association
PO Box 47126
Baltimore, MD 21224-7126

Signature

Date

Please note: Before you write your check, look at the address label on your social times.

If that date is 2007 or later, you do not owe dues for 2007 and you need do nothing.
If that date is 2006, then you do owe dues for 2007.

If there are no changes (name, address, telephone number, etc.) just show your name and spouse’s name in the blocks above, and sign and date the form.

Note: If you joined SSAA while you were still employed, have you since retired from SSA? Yes____ No____

DO NOT CUT OR MUTILATE THIS FORM: RETURN THE ENTIRE FORM.
DO NOT ATTACH YOUR CHECK WITH SCOTCH TAPE OR STAPLES.

THIS BLOCK FOR CORRECTIONS ONLY

Complete the following portion only if your address differs from that shown on the mailing label and/or your telephone number has changed.

New Address (Street, P.O. Box, Apt. No.)

City and State

Zip Code

New Telephone No. and Area Code

Email Address-Optional