Beneficiary Member options:

If you would prefer to join by monthly draft from your RSA check, please sign and return your membership application.

To request a Beneficiary application, please call our office at 800-844-7732 or 334-834-9116.

Payment for Beneficiaries

First Name *

Last Name *

Address *

Address2

City *

State *

Zip *

Phone *

Email *

Retired From

Membership *

FOREPAC *

Total Amount

Payment method

Square

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

Verification code*

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