Membership Application

The Retired Public Employees of Nevada (RPEN) was formed in 1977 to meet the challenges public employees face upon retirement. The challenges then and now are health insurance and protecting the Nevada PERS fund. Today RPEN continues its work to protect and support these issues for retirees and those still working. If you receive a monthly Public Employees’ Retirement System (PERS) pension, you do not automatically belong to RPEN.

RPEN works for retired and active public employees by:

Being a strong voice for retired and active public employees at the Nevada Legislature.
Supporting Nevada’s Defined Benefit retirement system.
Serving as an advocate at PERS and PEBP (health plan) board meetings and meetings of other legistlative,
state, and local goverment boards and committees.

RPEN has 17 chapters statewide. They meet on a regular basis with speakers who make presentations on topics of interest for public employees, retired and active. Chapters: Bi Valley (Yerington), Carson City, Churchill, Elko, Fernley, Henderson, Las Vegas, Lincoln, Mineral, Northern Tri-County (Battle Mountain, Lovelock, Winnemucca), Pahrump, Sparks, Summerlin, Tonopah, Two Rivers (Overton-Mesquite), Washoe (Reno) or White Pine

Please take a moment and complete the RPEN membership electronic application below.

RPEN Online Membership Form

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Birth Date*
MM slash DD slash YYYY
Email
Phone*
Employment Status*
- Retired
- Still Employed
Current Public Employer*
Retirement Date*
MM slash DD slash YYYY
Last Public Employer*
Do you have a spouse?*
- Yes
- No
Spouse's Name*
First Last
Spouse Birth Date*
MM slash DD slash YYYY
I wish to join the following chapter:*
Select your method of dues payment:*
- PERS Deduction
- ACH - direct bank account debit
- Send a check for your yearly dues.
Pers Deduction Authorization
By completing and submitting this section you are authorizing RPEN to establish a monthly PERS deduction for the payment of RPEN membership dues.
Is the PERS deduction from the account of the person listed above?*
- Yes
- No
Name on the PERS Account*
First Last
Number of PERS deductions per month:*
Please enter a number from 1 to 10.
If we have a problem establishing the PERS membership dues deduction how would you prefer that we contact you?*
- Telephone
- Email
Best Phone Number:*
Email Address
Consent*
PERS deduction authorization
I hereby authorize the Public Employees’ Retirement System (PERS) to deduct $7.00 per person per month for RPEN dues as I have designated below. I understand this will continue in the amount established by RPEN until I notify RPEN in writing to discontinue the deduction(s).
ACH Authorization - Direct Bank Account Deduction
This section authorizes RPEN to charge your bank account regularly for payment of your membership dues. You will be charged the amount indicated below in each billing period. A receipt for payment will be provided to you and the charge will appear on your bank statement as an "ACH Debit'" You agree that no prior notification will be provided unless the date or amount of the debit changes, in which case you will receive a notice from RPEN at least ten (10) days prior to the payment debit.
I choose to pay my dues:*
- Monthly - $7.00 per month deducted in the last week of each month.
- Yearly - $84 per year deducted in your RPEN membership anniversary month.
Is the ACH deduction from the bank account of the person listed above?*
- Yes
- No
Name on the bank account used for the ACH deduction:*
First Last
Bank account owner's address:*
Street Address Address Line 2 City State ZIP Code
Bank account owner's phone number:*
Bank account owner's email address:*
Bank Account Details
Bank Name:*
Bank Account Number:*
Bank Routing Number:*
Consent*
ACH bank account deduction authorization.
I authorize Retired Public Employees of Nevada, Inc. to debit my bank account as I have selected for my RPEN membership dues.

I understand that this authorization will remain in effect until I cancel it in writing and I agree to notify RPEN in writing of any changes in my account information or termination of this authorization at least fifteen (15) days prior to the next billing date.
Payment by check for yearly dues
Thank-you very much for choosing to join the Retired Public Employees of Nevada, Inc. (RPEN).

By selecting payment by check you are agreeing to send a check for your first year of RPEN membership dues ($84.00). You will be sent an invoice each year in the month in which you joined RPEN.

We will process your membership application as soon as we receive your check for payment of your dues.

Please send your check to:

RPEN
P.O. Box 2211
Carson City, NV 89702
Name
This field is for validation purposes and should be left unchanged.

RPEN works for retired and active public employees by:

RPEN Online Membership Form

Pers Deduction Authorization

ACH Authorization - Direct Bank Account Deduction

Bank Account Details

Payment by check for yearly dues