SUAA-UIC Membership Application |
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_____________________
Signature:___________________________________________________
Date:_____________________
Monthly deductions will begin on the first month following receipt of this form
and will continue until you inform the State Universities Retirement System
otherwise. Otherwise, submit a check for $30* payable
to SUAA-UIC. This will pay your dues for the ensuing 12-month period.
Similar payments will be required each year to continue your membership.
* after December 31, 2009, the dues will be $36