1111 S Abilene Ct.
Aurora, CO 80015
303/752-0660 ** 800/338-9337
Fax: 303/752-0835 ** 888/882-0835

THE RETIRED ENLISTED ASSOCIATION

ONLINE MEMBERSHIP APPLICATION
Please Note:  If you are mailing your application with your
check or faxing your application, DO NOT click "Submit Form", simply
print out the page after you have filled it out.

Name:   Birthdate:
Address:
City: State: Zip:
Telephone No: (xxx-xxx-xxxx): Fax No: (xxx-xxx-xxxx):
Email Address: Spouse Name:
Branch of Service:    Years of Service Grade/Rank:
If you are disabled, what is your VA Rating?
Chapter: Recruiter: Member No.

Regular Member        Associate Member

New Application
Renewal, Enter Your
Membership No.
Name: 
QPL Payment, Enter Your
Membership No.
Name: 
 

Payment Options: Send credit card information or check information through our secure server.

Credit Card No:

Name as it Appears on Credit Card: 

Expiration Date:

************************************************

 

- Online Check Form -

A check for the amount of your order will be drawn upon your checking account made payable to "The Retired Enlisted Association". 

Please fill out the form below completely.

Part #A -- Check number:  

Part #B -- Branch Number:
(usually in a format similar to 50-9999/9999 - upper right hand on check)

Part #C -- Your Name and Address: (exactly as it appears on check):

Part #D -- Bank Name and Address: (exactly as it appears on check):

Part #E -- Bank Transit Number:
(Must be a 9 digit number)

Part #F -- Account Number:

Please Note:  If you are mailing your application with your
check or faxing your application, DO NOT click "Submit Form", simply
print out the page after you have filled it out.