Join Us Social share icons You must have JavaScript enabled to use this form. Leave this field blank Yes, I will help protect my pension by joining AFSCME Minnesota and Dakotas Retirees United today! Dues are only $3 a month. Retiree Name First Name Last Name SS# xxx-xx- (Last 4 Digits Only) While working I was a member of: Minnesota AFSCME Council 5 Minnesota & Dakotas AFSCME Council 65 Other Enter other… Retirement System Minnesota State Retirement System (MSRS) Public Employees Retirement Association (PERA) None Check here if surviving beneficiary of the retiree. Beneficiary Name First Last Street Address Apartment, Suite, etc. City State - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Personal Email Cell Phone † † By providing my cell phone number I consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME and its affiliated labor, political and charitable organizations on any subject matter. My carrier’s rates may apply. I may modify my preferences at https://www.afscme.org/tcpa. By providing my cell phone number I consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME and its affiliated labor, political and charitable organizations on any subject matter. My carrier’s rates may apply. Authorization I hereby join AFSCME Minnesota and Dakotas Retirees United and designate said chapter as my duly chosen and authorized representative to promote and protect my economic welfare to the extent authorized by the law. I hereby request and authorize the deduction from my monthly retirement allowance in the amount certified by the retiree chapter as the current rate of dues. Current dues are $3 per month. Notice: In order to comply with Internal Revenue Services rulings, be advised that your membership dues are not deductible for federal income tax purposes. Signature Reset My electronic signature is a binding and valid signature. By signing here I agree to all of the terms and conditions set out in this authorization, which apply to my membership, dues payments and, if applicable, PEOPLE payments. Sign Your Card