Retired Membership Enrollment

Retired Membership Enrollment Form

Fields with a red asterisk * are required for enrollment

Personal Information

Actual Retirement Date *

2 digit month, 2 digit day, 4 digit year

Last 4 digits of Social Security Number * 4 digits, no dashes

First Name *

M.I.

Last Name *

Apt. #

Address *

City *

State *

Zip Code * 5 digits

Contact Information

Cell Phone * 10 digits

Personal Email *

Allow Text Messages Data and messaging rates apply

Monthly Deduction From Retirement Check

Monthly Deduction * Includes $3.00 per month voluntary contribution for AEA’s AVOTE to help elect friends of education to public office in Alabama.

Click here to deduct $3.00 if you choose not to help elect legislators who support COLAs and PEEHIP funding for retirees.

Member Signature *

Retirement Check Deduction: I authorize the Teachers’ Retirement System of Alabama to deduct monthly dues from my retirement check for AEA/NEA-Retired and AERA. Current dues amount above will increase with the enactment of future COLAs. My membership deductions are to continue until revoked by written notification to Teachers’ Retirement System of Alabama.

Digital Signature *

I understand typing my name or initials on the line above constitutes a legal digital signature confirming my understanding and agreement to the above.