Retiree Healthcare National Advocacy Group – Retirees - Seniors – 800-398-3044

If you would like to join our organization and/or help with our mission, please contact us by filling in the information below. We are building a powerful grassroots organization to contact Members of Congress personally in Washington and in their home districts and states. We provide all the training on proper way to get an appointment and how to get your position across to him or her, positively.

Note all information is optional except LAST NAME & TELEPHONE and
EMAIL address if you have one.

First Name:

Last Name (required):

Company Retired From (retiring soon):

Know other retirees? Yes - No Company retiree clubs? Senior Community groups? Organized senior groups? Senior travel Clubs? Online Senior Chat Groups Other groups:

Street Address:

Address (Suite - Apt.):

City:

State:

Zip Code:

Congressional District:

Telephone (9 AM - 5PM):

Telephone After 5 Weekends:

How can you help? Know Key Person Willing to recruit others Willing to Write Congress Willing to meet with Congress Will Contribute Other - Please Call me

Email Address (skip if none)

Union - Management Retired Management Retired Union Still Working - Union Still Working - Management Retired - Neither Still Working - Neither

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We also need your financial support to continue our mission. Print and fill out our donation form, make out a check to: ProtectsSeniors.Org, then send to:

ProtectSeniors.Org
PO Box 758904
Baltimore, MD 21275-8904

(Please do not send checks to Pennsylvania Ave. address as this will delay payment.)

Please consider making a secure online donation with your credit card by clicking below:

Click here to go to printable Payment Form. It is in Adobe PDF file format that requires a copy of the free Adobe Acrobat reader software installed on your computer. Click here to go to Adobe website to download and install the free Acrobat reader. Click your browser's BACK button to return here.

Please remember your donations to ProtectSeniors.Org are NOT tax deductible.