Aetna Retirees Association, Aetna's promise of benefits to former Aetna employees

ARA Membership Application/Renewal

The mission of ARA is to involve retirees in protecting the various benefits  –  medical/dental, vision, prescription drug, life insurance benefits and pensions  –  that Aetna committed itself to, so that those retirees may live in retirement as Aetna promised they would. If you are an Aetna retiree and support this goal, we urge you to join ARA (and to renew your membership in subsequent years).

Fill out the form below, or if you prefer print out a printer friendly version of this form by clicking here. Your personal information is private and will not be shared with anyone.

This is my: Initial Membership Application    Membership Renewal
Last Name* First Name* Middle  Initial
Address*:
Address (cont.):
City*:
State*:      (Please let us know if this or your email address changes in the future.)
Zipcode*:     
Phone*:     -   - 
Email*:
Date of Birth:  
Spouse's Name:  
   * = required

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If you are interested in volunteering your assistance in this work, please let us know what amount of time you could provide and what particular skills you would like to offer. (We are currently in particular need of those with web design and media relations experience as well as those willing to help with mailings and other administrative support. Over time we will be seeking those willing to coordinate regional activities as well.)
Volunteer / General Comments:

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Annual Dues are $20.  Contributions of $100 or more qualify the donor as a Benefactor. Please note dues and contributions are not tax deductible.

Payment may be made by check or credit card. Please make checks payable to Aetna Retirees Association, Inc. and send to PO Box 280165, East Hartford, CT 06128.

Dues: $  (Do not add cents – e.g., enter 20, not 20.00)
Contribution: $ 
Total: $ 

(If you want to submit the form and make a credit card payment, the order is not critical. Note that any amounts entered on this form will have to be re-enterd in the credit-card/PayPal process. Also, the credit card capability is PayPal sponsored such that you will not see the credit card option offered until you enter the amount on the PayPal screen (in the "Price per item" space) and hit "continue".)

Note: we have been advised by an ARA member (echoed at several internet sites) that if you are using Windows Vista as your operating system, you may experience a problem in paying by credit card directly (as opposed to going through an existing PayPal account – the other option under "Pay by Credit Card").
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