Membership Application

Name: (LAST)________________________  (FIRST)_______________________  (M.I.)____

Address: ____________________________________________________  Apt.#_________

City:_____________________________    State:________  Zip Code:___________

Home Telephone #________________________

E-mail address:___________________________

UIC Annuitant____        Survivor of UIC Annuitant____         UIC Employee_____         Other_____

Department affiliation at UIC_____________________        Spouse_____________________

UIC Employees: To pay by payroll deduction, click here.

SURS Annuitants: To pay by deduction from your SURS benefit check, please sign below: I hereby authorize the State Universities Retirement System of Illinois to deduct from my benefits check the amount as certified by the UIC SUAA chapter as the current rate of dues.
Signature:___________________________________________________ Date:_____________________
Monthly deductions will begin in the first month following receipt of this form and will continue until you inform the State Universities Retirement System otherwise.

To pay by check: Please submit a check payable to UIC-SUAA for $44 for 12 months of membership or $88 for 24 months. Your membership will begin with the first month following receipt of this form.

Note: You may also join and pay online at the SUAA website.

Mail application to:

State Universities Annuitants Association (SUAA)
217 E. Monroe St., Suite 100
Springfield, IL 62701

Last modified: Feb. 12, 2015