P.O. Box 77473

Washington, D.C. 20013

Last Name_______________ First___________________________ Initial____

Home Address________________________________________________________

City_______________________________ State______ Zip__________

Home Phone_________________ Bus/Cell__________________

Email Address (H)________________________ (W)_________________________

CURRENT BIG MEMBERS INFORMATION (For Information Only)

(Current BIG Members must complete the next Section, when applying to join RMC)

Type of BIG Membership: Regular_____ Life_____ Gold Plus_____ Associate_____

BIG Membership Number: _______ Current Expiration Date: ___/___/_____

Name of current BIG Chapter you belong to: ________________________________

(If you are not currently a member of a local BIG Chapter, please write in ‘At Large Member.)

Public Service Agency Information and Retirement Status:

Agency Retired From:_________________________________ Date of Retirement: __/__/_____

Agency Retiring from:_________________________________ Projected Ret. Date: __/__/_____

RMC MEMBERSHIP APPLICATION / DUES PAYMENT INFORMATION

(New members to BIG must submit both ‘RMC’ and ‘National’ annual dues with their application submission.)

Retired Members Chapter Annual Membership Dues ( Due: all new RMC Members):

Regular: $ 50 ___ Associate $ 35 ___ (Non-voting – Chapter Level)

National Annual Membership Dues, not currently paid up, must be submitted with your Application: Regular: $ 35 ___ Associate $ 25 ___ (Non-voting – National Level)

Life: $300 ___ Gold Plus: $250 ___ (Must be a Life Member)

Total dues submitted with this application $________ (Make checks/money orders payable to: Retired Members Chapter, RXI and submit application and fees to :

RXI Retired Members Chapter

Blacks In Government

P O Box 77473

Washington, DC 20013

For additional questions regarding the RMC Chapter, please contact Claire Cashwell, President at (301) 567-3012(home) or RMC@bignet.org .

“Committed to Equity, Excellence and Opportunity"