ADD AN ADDITIONAL GIFT

Support UWRA Operations

Please consider making an additional gift to support UWRA’s operations. We use these generous donations to cover the cost of membership or event attendance for retirees for whom these costs represent a significant barrier, and to keep the cost of our programs and services free or very low for members.

Gift Amount

Recurring Annually

Member Information

Prefix

* First Name

* Last Name

Suffix

Pronouns

He/His

She/Her

They/Them

International Address?

Yes

No

* Address

Street Address 2  

Street Address 3  

* City

State

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico US Minor Outlying Islands Virgin Islands of the US American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico US Minor Outlying Islands Virgin Islands of the US

Province

* Zip/Postal Code

Country

Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctic, French & Southern Antarctica Antigua Argentina Armenia Aruba Ashmore & Artier Islands Australia Austria Azerbaijan Bahrain Bali Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia-Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British West Indies Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Canton & Enderbur Islands Cape Verde Cayman Islands Central African Empire Chad Chile Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Coral Sea Islands Territory Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Falkland Isl. (Islas Malvinas) Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Georgia Germany Ghana Gibraltar Gilbert Islands Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island, McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Johnston Atoll Jordan Kamchatka Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Man, Isle of Martinque Marshall Islands Mauritania Mauritius Mayotte Mexico Midway Islands Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia (S.W. Africa) Nauru Navassa Island Nepal Netherlands Netherlands Antilles New Caledonia New Hebrides New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Ireland Norway Oman Pacific Islands Trust Pakistan Palestinian Territory (Occupied) Panama Panama Canal Zone Papua New Guinea Paracel Islands Paraguay People's Republic of China Peru Philippines Pitcairn Poland Portugal Qatar Republic of Lithuania Republic of Palau Reunion Réunion Romania Russia Rwanda S. Georgia and S. Sandwich Islands Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre & Miquelon Saint Vincent Samoa San Marino Sao Tome & Principe Saudi Arabia Scotland Senegal Serbia Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka St. Christopher-Nevis Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Tasmania Thailand The Bahamas The Gambia Timor-Leste Togo Tokelau Islands Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu U.S. Minor Outlying Islands U.S.Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom Upper Volta Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands British Wake Island Wales Wallis & Futuna Western Sahara Western Samoa Yemen Yugoslavia Zaire Zambia Zimbabwe

Phone

* Email

UWRA Member Number (if known)

Spouse/Partner Information

Prefix

* First Name

* Last Name

Suffix

Pronouns

He/His

She/Her

They/Them

UWRA Member Number (if known)

UW/HIGHER EDUCATION SERVICE HISTORY

We use this information to verify your membership eligibility.

* Employment Category

Faculty, Librarians and other Academic Personnel

Professional Staff

Classified and Union-represented Staff

Academic personnel

* Employment Category

Faculty, Librarians and other Academic Personnel

Professional Staff

Classified and Union-represented Staff

Academic personnel

* Employment Status

UW Retiree or Past Employee

Current UW Employee

Retiree of Other Organization

* Please Specify Other Organization

Date of Birth

* Retirement Year

* Department

* Employment Status

UW Retiree or Past Employee

Current UW Employee

Retiree of Other Organization

* Please Specify Other Organization

Date of Birth

* Retirement Year

* Department

MEMBER DEMOGRAPHIC INFORMATION

The UWRA is committed to promoting the multi-faceted aspects of gender, racial, and social justice, a commitment we seek to express in all arenas of the UWRA’s operations, activities, and collaborations. Responses to the following demographic questions are optional, but we hope you will share this information with us so that we can do our best to ensure that the UWRA’s community is one in which all members feel valued and respected, and drawn to participate fully. The UW does not make disaggregated demographic information about UW retirees available to the UWRA; therefore, we seek this information via this membership form.

This information is held in the highest confidence; it is available only to the UWRA Executive Director and Associate Director. Analyses and reports ensure anonymity; that is, aggregate responses are not traceable to and do not allow identification of individual respondents. The UWRA retains ownership of our own membership information; this is not the property of the UW and is never shared with any other entities.

* Racial and/or Ethnic Background

Asian or Pacific Islander

Black or African American

Hispanic or Latinx

Native American or Alaskan Native

White or Caucasian

A race or ethnicity not listed here

Prefer not to answer

* Gender Identity

Female

Male

Non-binary/gender non-conforming

Prefer not to answer

* Physical and Other Ability Statuses

Blind or vision impaired

Cognitive Impairment

Deaf or hearing impaired

Mobility Impaired

An impairment not listed here

Billing Information

Same as Member Information?

Yes

No

Prefix

* First Name

* Last Name

Suffix

International Address?

Yes

No

* Address

Street Address 2  

Street Address 3  

* City

State

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico US Minor Outlying Islands Virgin Islands of the US American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico US Minor Outlying Islands Virgin Islands of the US

Province

* Zip/Postal Code

Country

Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctic, French & Southern Antarctica Antigua Argentina Armenia Aruba Ashmore & Artier Islands Australia Austria Azerbaijan Bahrain Bali Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia-Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British West Indies Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Canton & Enderbur Islands Cape Verde Cayman Islands Central African Empire Chad Chile Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Coral Sea Islands Territory Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Falkland Isl. (Islas Malvinas) Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Georgia Germany Ghana Gibraltar Gilbert Islands Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island, McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Johnston Atoll Jordan Kamchatka Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Man, Isle of Martinque Marshall Islands Mauritania Mauritius Mayotte Mexico Midway Islands Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia (S.W. Africa) Nauru Navassa Island Nepal Netherlands Netherlands Antilles New Caledonia New Hebrides New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Ireland Norway Oman Pacific Islands Trust Pakistan Palestinian Territory (Occupied) Panama Panama Canal Zone Papua New Guinea Paracel Islands Paraguay People's Republic of China Peru Philippines Pitcairn Poland Portugal Qatar Republic of Lithuania Republic of Palau Reunion Réunion Romania Russia Rwanda S. Georgia and S. Sandwich Islands Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre & Miquelon Saint Vincent Samoa San Marino Sao Tome & Principe Saudi Arabia Scotland Senegal Serbia Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka St. Christopher-Nevis Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Tasmania Thailand The Bahamas The Gambia Timor-Leste Togo Tokelau Islands Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu U.S. Minor Outlying Islands U.S.Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom Upper Volta Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands British Wake Island Wales Wallis & Futuna Western Sahara Western Samoa Yemen Yugoslavia Zaire Zambia Zimbabwe

* Email

Payment

Credit Card