Update your membership information on this page.

Save time and postage - use this form to change your address, beneficiares, and more

Has anything changed for you in the last year? New address? Get married? New addition to the family? Fill out the form below to help us keep your information current.

 

 

 

Section 1: Your personal information.


First Name
Last Name


City
State
Zip Code

Mobile Phone

e-mail address
Please use a personal, rather than city, email address here.

SSN


Date of Hire
Date of Retirement/Expected Retirement

 

Section 2: Your dependents and beneficiaries.



Name of Spouse or Partner (first, last)


Spouse's SSN


Spouse Occupation

B. Children/Dependents

 

Child 1 Name (first, last)
Date of Birth
Child 1 SSN

Child 2 Name (first, last)
Date of Birth
Child 2 SSN

Child 3 Name (first, last)
Date of Birth
Child 3 SSN

Child 4 Name (first, last)
Date of Birth
Child 4 SSN

 

Other information

 

Section 3: Emergency Information.

This information will be used in case of member serious injury or death only.

 

Family Liason
Please designate a fellow member of the department who will serve as your family advocate in the event of your serious injury, death, or other traumatic incident. The Family Liaison will coordinate supportive efforts for you and your family, and be the primary point of contact for Relief Association, Union, Department, and related agencies.




Submit this information

 

 

 

 

 

 

 

 

 

 

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