MEMBERSHIP REGISTRATION

"*" indicates required fields

**Information with an asterisk * is required.**

Name(s)*

Last Name(s)*

Address*

Address Address Line 2 City State or Province Zip Code Country

Actual/Approximate Retirement Date*

Telephone*

Cell phone*

Email*

Citizenship

IDB ID Number*

Retirement plan type

International

Local

EMERGENCY CONTACT (Optional)

Name of spouse / partner / family member (optional)

First Last

Email of spouse / partner / family member

Phone of spouse / partner / family member

MEMBERSHIP TYPE

1) INTERNATIONAL MEMBERSHIP*

I authorize the following:

I authorize the Salaries and Benefits Payments Section of the IDB to deduct from my monthly pension payment the monthly membership fee as established from time to time by the Board of Directors of the IDB Retirees Association (currently $5.00 per month).
I understand that this fee may be adjusted from time to time by the Board in an amount adequate to support the financial sustainability of the Association.*

* Article 4(a)(i) of the By-Laws of the IDB Retirees Association authorizes the Board of Directors of the Association to determine membership fees. Any adjustments to the currently applicable fees will be explained to the membership during the presentation of the Financial Report of the Association at the next annual general meeting of the Association, consistent with the Board’s fiduciary responsibilities.

From this date*

2) LOCAL MEMBERSHIP*

I authorize the following:

As a local Retiree I authorize the Salaries and Benefit Payments Section of the IDB to deduct from my monthly pension payment the monthly membership fee as established from time to time by the Board of Directors of the IDB Retirees Association (currently $2.00 per month for local retirees).
I understand that this fee may be adjusted from time to time by the Board in an amount adequate to support the financial sustainability of the Association.

* Article 4(a)(i) of the By-Laws of the IDB Retirees Association authorizes the Board of Directors of the Association to determine membership fees. Any adjustments to the currently applicable fees will be explained to the membership during the presentation of the Financial Report of the Association at the next annual general meeting of the Association, consistent with the Board’s fiduciary responsibilities.

From this date*

3) WIDOW(ER) MEMBERSHIP

I declare to receive a pension from the Inter-American Development Bank in my capacity as widow(er) of the deceased retiree mentioned here and I request the corresponding free quotas

Name and surname of deceased retiree

Approx date of spouse death

Your name and address will be automatically included in the Member Directory, unless you request that it be excluded.*

Yes, I want my data to be displayed in the Members directory

I do not want to be included in the member directory

Do you want to receive regional daily news from the Bank via email?*

Yes

Signature (type your name)*

Date*

Signature

Phone

This field is for validation purposes and should be left unchanged.

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MEMBERSHIP REGISTRATION

**Information with an asterisk * is required.**

EMERGENCY CONTACT (Optional)

MEMBERSHIP TYPE

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