Benefit Eligible Employee and Emeriti/Retiree Membership Application

I would like to
I am a
Membership Details
(269) ###-####

Important tax information for employees

I hereby authorize the payroll department to deduct taxes from my paycheck. I understand this agreement is non-revocable and cannot be refunded. I understand that $150 or $270 (depending on my chosen option) will be reported as extra income, and I will be taxed on this amount.

Please note Option 1 is free to retirees and their spouses.