Mail Completed Form To:
P.O. Box 8447
Columbia, SC 29202-8447
South Carolina State Employees Association
(First) (MI) (Last)
Street Address:
City: State: Zip Code:
Mailing Address: (If Different)
City: State: Zip Code:
Social Security Number: ______ - ____ - ________ Cell Phone: (______) ________-____________
Area Code
State Agency: Recruited By:
For your convenience payroll deduction is available at - ONLINE Services utilizing the SCEIS, Employee Self-Service
payroll deduction system. Select 2208-SC State Employee. If you need assistance setting up your SCEIS account, please contact your
Human Resource Department.
I hereby authorize the SC Retirement Systems to withhold $ ___________ (per month) from my retirement pension.
Signature ___________________________________________
Date ___________________________________________
Credit Card Payments
For your convenience, you may pay your annual membership dues by Visa, MasterCard, American Express, and Discover at ONLINE Services.
Check or Money Order
If you wish to pay the total amount of annual dues by check or money order, enclose your check or money order made payable to
the “SC State Employees Association”.
Membership Dues Schedule
Per Pay Period Monthly Annual
Annual Income
Less Than $35,000 $2.50 $ 5.00 $ 60.00
Annual Income
Greater Than $35,000 $5.00 $10.00 $120.00
Associate Member -------- -------- $ 60.00
Check One: Check One:
__ Active Employee __ New Member
__ Retiree __ Renewal
__ Associate
Membership Enrollment