MEMBERSHIP INTERNATIONAL - Association of Retirees of the IADB

Name [Information with asterisk is mandatory]*
Nombre Apellidos
Address*
Address Dirección 2 City State/County Zip Code Citizenship
Actual/Approximate Retirement Date*
Telephone*
Cell phone*
Email*
IDB ID Number*
Name of spouse / partner
First Last
Your name and address will be automatically included in the members Directory, unless you specifically request that it be excluded. Exclude:*
- Yes (Exclude from directory)
- No (Exclude from directory)
Would you like to receive our daily news of the region by email?*
- Yes (Receive daily news)
- No (Receive daily news)
AUTHORIZATION FOR THE DEDUCTION OF THE MEMBERSHIP FEE*
- You authorize the Salaries and Benefits Payment Section of the Inter-American Development Bank to deduct US $ 3 of your monthly pension for the membership fees of the IDB Retirees Association.
From this date*
Signature (type your name)*
Date*
Signature