Membership Interest Form

Interested in becoming a member? Please complete this interest form as completely as possible. The information you provide will allow us to verify your eligibility. Once verified, you will receive an email with information for the dues payment process. Once that is completed, you will receive your membership welcome and information.

Thank you for your interest in joining us!

Membership Application - Revised

Name(Required)

First Middle Last

Preferred Name

Name

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Mobile Phone Number (US only)

Home Phone Number (US only)

Email(Required)

Spouse's Name (if applicable)

First Last

Years of Service as an Agency employee

Please enter the years during which you worked (e.g. 1980-2000)

Directorates / Mission Centers

Offices

How did you hear about CIRA?

Agency Employment/CIRA Member Reference

Reference Phone Number or Email

I Understand(Required)

I understand the information provided will be verified including employment.

Member Directory(Required)

I give permission to CIRA to add my name, city, state, and email address into a Member Directory on the password protected members only website.

Please do not add my name, city, state, and email address into a Member Directory on the password protected members only website.

Quarterly Newsletter (Available on the website)(Required)

I would prefer a electronic copy.

I would prefer a printed/mailed copy.

I would like to receive both.

Date of Application