Provide us with your contact information and we will mail you the requested information.  Also, please tell us what you think about our web site, benefits, and services.

Contact Information

Name
Address
City, State, ZIP
E-mail Address

Please send me information on the RAUS benefits marked below. (Check all that apply)

	Benefit	Underwritten by
	RAUS Membership (if not already a member)
	RAUS CHAMPUS/CHAMPVA Supplement	Hartford Life
	RAUS TRICARE Prime Supplement	Hartford Life
	RAUS TRICARE CHAMPUS Extra, Standard Supplement	Hartford Life
	RAUS Group Term Life Insurance	Connecticut General
	RAUS Medicare Supplement	Monumental Life
	RAUS Accident Plan Insurance	American Heritage
	RAUS Cancer Insurance	American Heritage
	RAUS Quarterly Newsletter Subscription ($10/year for non-members)

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Copyright © 1997-2009 Retired Association for the Uniformed Services, Inc.
Revised: October 16, 2009