Membership Application

Name___________________________________________________

Address_________________________________________________

City________________________State_________Zip Code________ 

Home Phone________________Cell Phone_____________________

E-Mail__________________________Birthday__________________

Date of Retirement_________ Retired from state/county___________

Position when retired_______________________________________

Activities in which you would like to become involved

o Scrapbook o Necrology

o Volunteer services o Cultural Affairs

o Directory o Devotions

o Legislation o Hospitality

o Membership/Retirement planning

o Newsletter o Phone Committee

o Scholarships o Courtesy

o Music o Computer

o Any other talents you can offer

_________________________________________________________

Print this application, complete and mail with your check for $40, which

includes state as well as local membership. Mail to

Janet Ford

715 Beech Road

West Palm Beach, FL 33409-6111

Phone 561-683-3665