Application form for partial dues waiver

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First Name: *

Last Name: *

Address: *

City: *

State:

Zip Code:

Phone:

Email:

Birth Date:

I am applying for a partial dues waiver for 2013:

Yes

I qualify for the partial waiver because: (Please choose one of the following) :

I am on temporary leave from the work force (for any reason, including unemployment or partial disability), and I anticipate I will earn no more than $31,600 from actuarial activities in 2013.

I am under age 70, retired from active employment, and anticipate that I will earn no more than $31,600 from actuarial activities in 2013.

Please note:
If you are granted a partial waiver and you earn more than $31,600 from actuarial activities in 2013, you are obliged to notify the Academy and pay the full dues amount ($605).

AmericanAcademyOfActuaries

Application form for partial dues waiver

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