1301 West 7th St. Little Rock, AR 72201 | (501) 378-0187

MEMBERSHIP APPLICATION

JOIN ASEA

HOME LOGIN

STEP 1: Choose membership type

EMPLOYED - Payroll Deduction

^$2

$2/paycheck

Active Plan

Must currently be employed by the state of Arkansas

Please proceed; no charge at this time

Deduction will be processed by your payroll administrator

EMPLOYED - Annual

^$52

$52/Year

VALID FOR ONE YEAR

Must currently be employed by the state of Arkansas

Payment collected during application process

$52 for 1 year

RETIRED

^$24

$24/Year

VALID FOR ONE YEAR

Formerly employed by the state of Arkansas—retired

Payment collected during application process

$24 for 1 year

RETIRED - Lifetime

^$200

$200 Once

ONE TIME PAYMENT

Formerly employed by the state of Arkansas—retired

Payment collected during application process

$200 one-time

To continue the membership process, fill out the form below.

FIRST NAME

LAST NAME

REFERRED BY

PERSONNEL #

APPLICANT AGENCY

EMAIL ADDRESS

MOBILE PHONE

PASSWORD (MIN. 6 CHARS)

ADDRESS

CITY

ZIP

SIGNATURE & SUBMIT

I solemnly swear or affirm that the information provided in this application is true and correct to the best of my knowledge and belief.

CHECK THE SIGNATURE BOX TO SUBMIT YOUR INFORMATION

MEMBERSHIP APPLICATION

JOIN ASEA

HOME LOGIN

STEP 1: Choose membership type

EMPLOYED - Payroll Deduction

^$2

EMPLOYED - Annual

^$52

RETIRED

^$24

RETIRED - Lifetime

^$200

SIGNATURE & SUBMIT

.:| SUBMITTING |:.

BILLING INFORMATION

Payment information successfully sent.