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LLRA Membership Application Form

You may submit your membership electronically via this form.

If your spouse retired from LLNL as well, please fill out a separate form for your spouse.

Please write to

if you do not receive an email confirmation within a few minutes after you submit your form.

If you prefer to submit a form by mail, you can use the download button below to obtain a printable form.

NOTE:  Livermore Laboratory Retirees Association (LLRA) is not sponsored by or affiliated with Livermore Laboratory Employee Services Association (LLESA) Inc. or Lawrence Livermore National Laboratory (LLNL).

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