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Membership Sign Up Form

Federal Employees Benefit Association Member Sign Up
*Please fill out the required fields below. Please be assured that your information is secured.
*First Name: *Last Name: Middle Initial:
*Home Address: *Home Phone:
*City: *State: *Zip Code:

For verification purposes, please provide the following information:
*Work Address:
*City: *State: *Zip Code:
*Email: *Work Phone:  Ext.:
Agent Referral Name:

Once you are signed up as a FEBA Member, you will receive a FEBA ID card and FEBA Working Advantage ID number at your home mailing address.