CPRS Membership Form

http://www.retirementsecurity.org

Please complete the form below. In most cases, your Web site access will be activated within
24 hours of approval of your membership and an invoice will be mailed to you.

Contact Information

First Name:

Last Name:

Organization:

Address Line 1:

Address Line 2:

City:

State:

ZIP Code:

E-mail Address:

Phone Number:

Fax Number:

Membership Options

Voting Members
Statewide Pension Plan (10 cents per active member, not to be less than $1,000 nor more than $15,0000)
Non-Statewide Pension Plan (10 cents per active member, not to be less than $500 nor more than $$15,000)
Association of Pension Plans (10 cents per active member, excluding members covered by another CPRS membership, not to be less than $1,000 nor more than $15,000)
Related Organization, i.e., Employee, Retiree or Employer Group (10 cents per active member, excluding members covered by another CPRS membership, not to be less than $500 nor more than $15,000)

Non-Voting Members
Associate ($500)

If you are interested in supporting the coalition but do not fall into any of these categories, please contact us.