Forms
Pennsylvania Association of School Retirees
Legislative/Political Education Committee
CONTRIBUTION FORM
Name ___________________________________________________
Address _________________________________________________
_________________________________________________ Amount Enclosed $______________________
Phone ___________________________________________________ Thank you for your support!
Please make checks payable to L/PEC. Mail to 878 Century Drive, Mechanicsburg, PA 17055-8406
Did you know that a campaign to urge passage of a single piece of legislation can cost the association over $200,000?
Lancaster County School Retirees
Application for Local Membership
Please use this form to join as a new member or to renew your membership.
send a check payable to LCSR/PASR and enclose a self-addressed stamped envelope.
Lauren Buchmann, Membership Chairman
134 Creekgate Court
Millersville PA 17551-2134
Pleases Check Membership Category:
_____Life ($250.00) _____Annual ($15.00) _____3 Year ($40.00) _____Associate ($15.00)
Name ___________________________________________________Phone___________________________________DOB______________
Address _________________________________________________City_________________________State__________Zip_____________
Year Retired____________District____________________________________________ Position_________________________________
E-mail address ______________________________________________________________________________________________________
Visit our website at https://thepasrwixsite.com/lancasterpasr
Application for State Membership
Pennsiylvania Association of School Retirees
Please use this form as a new member or to renew your membership.
Make check payable to pASR and send the application and check to:
PASR
878 Century Lane
Mechanicsburg, PA 17055-4375
Select your membership option:
_____Annual Membership ($60.00) _____Associate Membership ($60.00) _____Life ($700)
_____3-Year ($150.00) _____Half Life (2 payments of $#50.00)
Name ___________________________________________________Phone____________________________DOB________________
Address ___________________________________________City_______________________________State________Zip__________
District___________________________________________Retirement Date______________Years of Service _______________
E-mail address ___________________________________________________
Are you a member of a local PASR Chapter? ________________If so, which one______________
Note: Membership dues payments may not be deductible for federal income tax.