Membership Interest Form

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Interested in becoming a member? We have a two-step process. 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 to join the website and to complete the dues payment process.

Thank you for your interest.

Membership Application - Revised

Name(Required)

First Middle Last

Preferred Name

Name

Date of Birth(Required)

MM slash DD slash YYYY

Address(Required)

Street Address Address Line 2 City State ZIP Code

Preferred Phone Number (US only)(Required)

Alternate Phone Number (US only)

What type of phone?(Required)

Mobile

Home

Business

What type of phone?

Mobile

Home

Business

Email(Required)

Spouse's Name (if applicable)

First Last

Directorates / Mission Centers

Offices

Years of Service as an Agency employee

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

How did you hear about CIRA?

Agency Employment/Current 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

MM slash DD slash YYYY