Application form for partial dues waiver Share First Name Last Name Address City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOut of CountryOhioOklahomaOntarioOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Phone Email Birth Date I am applying for a partial dues waiver for 2019 Yes A member qualifies for a partial dues waiver if he or she meets either of the following criteria: (Please choose one of the following) The member is on temporary leave from the work force for any reason, including unemployment or partial disability, and certifies that he or she anticipates earning “no significant income” (as defined below) from actuarial activities in the forthcoming calendar year. (A member in this category must certify annually that he or she meets the stated criteria, by re-applying each year for a partial dues waiver). The member is under age 70 and is retired from active employment, and anticipates earning “no significant income” in the forthcoming calendar year. (A member in this category who is under age 55 must certify annually that he or she meets the stated criteria, by re-applying each year for a partial dues waiver. A member in this category who is age 55 or older must so certify only in the first year in which he or she is in this category and need not reapply in subsequent years; however, if such a member ceases to be in this category prior to age 70, he or she must notify the Academy office and will no longer be eligible for such waiver.) *The term “no significant income” shall mean earning no more than 80 percent of the U.S. per capita income as most recently published by the U.S. government, rounded to the nearest $1,000 (currently $41,000). The term “income” for purposes of this policy shall mean and refer to earned income, including the definition of earned income as may appear in various sections of Title 26 of the U.S. Code, as in effect at the time of making such determination, and is not intended to include income from investment activities unrelated to employment or from Social Security, pensions, or comparable sources. Waivers are based on a member's status as of Jan. 1, 2019. If you are granted a partial waiver, your dues for 2019 will be $135. You will be billed after the request is approved. If you are granted a waiver and you no longer meet the stated criteria, you are obliged to notify the Academy and pay the full dues amount ($675). Other special circumstances warranting a partial or full waiver of dues will be considered by the Academy’s Membership Committee. Questions? If you are not sure whether you qualify for a dues waiver, please contact Kasha Shelton at the Academy firstname.lastname@example.org, 202.223.8196). Math question 5 + 13 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.