Membership Form

Members of this SRSRA Corporation shall be limited to persons (excluding employees of the U.S. Department of Energy) who have been employed at or in direct association with the Savannah River Site (or the Savannah River Plant/Savannah River Laboratory as it was previously known) for at least five years and who have since retired from any such employment, as well as their spouses. However, the primary focus of the SRSRA Corporation shall be to provide service to participants in the Westinghouse Savannah River Company-Bechtel Savannah River Incorporated retirement plan or in the successor plan, currently called the "Savannah River Nuclear Solutions, LLC Multiple Employer Pension Plan".

Annual Dues

Dues may be paid up to 3 years (current plus 2 future years). The easiest way (for all of us) is online. Go to our WEB page – srsretirees.org – it lets you complete an electronic form and go to Paypal to make a payment via a credit card. Or you can complete this Membership Form and mail form/check to the address shown below.

Please check all that apply

Member Name

First NameLast Name

Retiree Retirement Date from SRS

Retirement Company

You can add your spouse for no extra charge.

Spouse Name

First NameLast Name

Spouse's Retirement Date (If SRS Retire, NA)

Date

Spouse's Retirement Date if SRS retiree, if not "NA"

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number (cell phone number preferred

Area CodePhone Number

Email (Providing your e-mail address allows SRSRA to send important communications to you electronically, including newsletters and membership confirmations. )

example@example.com

My Products

Retireee (Join or Renew)$25.00

Quantity

Surviving Spouse of an SRS Retiree (Join/Renew)$5.00

Quantity

Spouse of a member and another SRS retireeFree

Quantity

In ADDITION to my dues, I want to make a donation to the SRS Resource Center$25.00

You can make a donation of $25, $15, or $10

	Quantity	Price
25		$25.00
15		$15.00
10		$10.00

Item subtotal:

Total $0.00

Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info

Membership Form

My Products*

Payment Methods

My Products