WAEPA Membership Application

Applicant Name*
First Last
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 a citizen of the United States, and the last 4 digits of my social are*
I am employed by
I have been employed with this agency since
MM slash DD slash YYYY
I was employed by:
WAEPA Member Name*
WAEPA Member Number
Date of Birth is:*
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.
By clicking submit, you hereby elect to join WAEPA.