Prorated Retiree Dues (remainder of first year)

Choose the appropriate proration amount below.

Tickets	Price
Month of Retirement - January	$12.00 (+ $0.00 fee)

Month of Retirement - February	$11.00 (+ $0.00 fee)

Month of Retirement - March	$10.00 (+ $0.00 fee)

Month of Retirement - April	$9.00 (+ $0.00 fee)

Month of Retirement - May	$8.00 (+ $0.00 fee)

Month of Retirement - June	$7.00 (+ $0.00 fee)

Month of Retirement - July	$6.00 (+ $0.00 fee)

Month of Retirement - August	$5.00 (+ $0.00 fee)

Month of Retirement - September	$4.00 (+ $0.00 fee)

Month of Retirement - October	$3.00 (+ $0.00 fee)

Month of Retirement - November	$2.00 (+ $0.00 fee)

Month of Retirement - December	$1.00 (+ $0.00 fee)

Total: $0.00

Total

$0.00

Retiree Name

Retiree TM #

Billing Information

Name

Credit Card

Visa
Mastercard
American Express
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Address

Mobile Phone Number

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Choose the appropriate proration amount below.

Month of Retirement - January

Month of Retirement - February

Month of Retirement - March

Month of Retirement - April

Month of Retirement - May

Month of Retirement - June

Month of Retirement - July

Month of Retirement - August

Month of Retirement - September

Month of Retirement - October

Month of Retirement - November

Month of Retirement - December

Billing Information