East Tennessee State University

Retirees Association (ETSURA)


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ETSU RETIREES ASSOCIATION MEMBERSHIP APPLICATION

 

Membership is $5 per person per calendar year (January 1 through December 31).  Please use this form to renew your membership or become a new Association member.  For further information or to check the status of your membership, please call (423) 439-5825.


NAME: (Last) _______________________________ (First) ____________________ (MI) _______ (Title) _______________

SPOUSE'S NAME: (Last) __________________________ (First) ____________________ (MI) _______ (Title) __________

ADDRESS: (Street) ____________________________________________________________________________________

(City) ________________________________________________________________ (State) ______ (ZIP) ______________

TELEPHONE: ( _____ ) ______________________ EMAIL: ___________________________________________________

FORMER STATUS WITH ETSU: _________ FACULTY _________ STAFF

AMOUNT PAID ($5 PER PERSON): ______ $5              __________ $10

ACCOUNT NO.: Fund: 821350; Org: 79990; Banner Account: 29300; Program: 999; Chart: E

Make  check  payable  to  ETSU  and  mail to: 
East Tennessee State University
ETSURA, Office of Human Resources, Box 70564
Johnson City, TN 37614-1707. 
Your check will be your receipt.

 

 

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Mailing Address:  Office of Human Resources
ETSU Box 70564
Johnson City, TN  37614-1707
Telephone:  423-439-5825
Fax:  423-439-8354

Office Hours:  8 a.m. to 4:30 p.m. E.S.T. Monday - Friday
Office Location:  Rooms 308, Dossett Hall