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    > Active Members > Active Member Forms

Active Member Forms

If you're having trouble downloading the pdf file, you may need to upgrade to the latest version of Acrobat Reader. Please see the Acrobat Reader download link at bottom of this page. Upon completion of the necessary form, please return the original form to the Hampden County Regional Retirement Board, 67 Hunt Street, Suite 116, Agawam, Massachusetts 01001. If you have any questions, you may contact the Retirement Board at (413) 737-1344

Request for Withdrawal Form
Download: 1003applicationforwithdrawal.pdf

Beneficiary Nomination Form
For Actively Employed Members

Download: beneficiary_selection_1001.pdf



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Hampden County Regional Board of Retirement
67 Hunt Street, #116, Agawam, Ma 01001
Tel. (413) 737-1344 • Fax (413) 732-7999