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Rs5420 2013
MEMBER.
Instructions: Please print clearly in ink or type. Application must be signed and notarized on last page.
Employee: Complete items 1–3, 10–13 on page 2 and other applicable sections. Employer: Complete items 4–9a.
FOR A REGISTRATION NUMBER: Call 1-866-805-0990 or (518) 474-3081. Or fax the application to (518) 486-4382.
This completed membership application must be mailed to the Retirement System for the membership to be effective.
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