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Name: (LAST)_________________________ (FIRST)__________________________ (M.I.)____ Address: ______________________________________________________ Apt. #__________ City:_____________________________ State:____________ Zip Code:___________ Home Telephone #_____________________ E-mail address:___________________________ UIC Annuitant____ Survivor of UIC Annuitant____ UIC Employee_____ Other_____ Department affiliation at UIC_____________________ Spouse_____________________ |
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UIC Employees: To pay by payroll deduction, click here. SURS Annuitants: To pay by deduction from your SURS benefit check, please sign below: I hereby authorize the State Universities Retirement System of Illinois
to deduct from my benefits check the amount as certified
by the UIC SUAA chapter as the current rate of dues. To pay by check: Please submit a check payable to UIC-SUAA for $36 for 12 months of membership or $72 for 24 months. Your membership will begin with the first month following receipt of this form. Note: You may also join and pay online at the SUAA website.
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Mail application to:State Universities Annuitants Association (SUAA) |
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Last modified: May 22, 2012
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Questions? Email suaa@uic.edu
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