WAEPA Membership Application

First Name*
Middle Name
Last Name*
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Work Phone
Cell Phone
Email*
I hereby attest that I meet one of the following qualifications:*
- I am a civilian federal employee of the U.S. Government actively at work.
- I am a retired civilian federal employee. WAEPA will contact you at a later date for proof of federal employment.
- I am a spouse of a WAEPA member.
I am employed by
I have been employed with this agency since
Date Format: MM slash DD slash YYYY
I was employed by:
WAEPA Member Name*
WAEPA Member Number
I am a citizen of the United States, and the last 4 digits of my social are:*
Date of Birth is:*
Date Format: MM slash DD slash YYYY
My Gender is:*
- Male
- Female
Heard About Us (check all that apply)*
- TV
- Radio
- Co-worker
- Family
- Email
- Direct Mail
- Newsletter
- Facebook
- Linkedin
- Twitter
- Blog
- Other Social Media
- Metro Ad
- Open Season
- Conference
- New Hire Orientation
- Educational Seminar
- Pre-Retirement/Retirement
- Other Event Type
Confirmation*
- I attest that the answers to the questions above are true and will be the basis of issuing Membership with WAEPA.
CAPTCHA
By clicking submit, you hereby elect to join WAEPA and understand your one-time, $2.00 Membership Fee will be billed at a later date.