Retiree Benefit Action Center
Members Section
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Add to List Form

Use this form if you'd like to add your information to the association's web site. Doing so will allow other members to e-mail you through this web site without knowing your actual e-mail address. It will also give you access to the password protected list of members who have joined and accept e-mail to be sent to them. All of the information collected is used for Assocation purposes only. If you'd like to be able to e-mail other members that allow it, but don't want to allow others to send e-mail to you, just enter "No" on the form where it asks "Allow members to send you email through this site?"

Note: All highlighted field names are required. All others are optional.

First Name
Middle Initial
Last Name

Place Jr, Sr, etc. (but exclude periods) in this field.
Your Email

PO = Police Officer, FF = Firefighter
Allow members to send you email through this site?
City, State ,
If you live outside of the US, please type in the location and select "Outside of USA" in the pull down menu.
Pick a Username
This is not case sensitive. All usernames will be converted to lower case.
Pick a Password
This is case sensitive
Reenter Password



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