Membership Renewal Form (v.11.12.28)

	LSRC
MEMBERSHIP FORM This Page Last Updated: Wednesday, December 28, 2011

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If it's time for your Annual Dues payment - OR - IF you would like to enroll in our Club - OR - IF you have any changes to your information on file with us, use the handy form below so that we can keep your newsletters coming to you in a timely fashion. If you are mailing in the form, please print it, fill it out, and mail it.

FOR THOSE OF YOU THAT HAVE E-MAIL ADDRESSES

PLEASE MAKE SURE THAT THE ADDRESS WE HAVE FOR YOU IN THE E-MAIL ROSTER IS CURRENT, YOU WILL GET INFORMATION THAT COULD BE VERY IMPORTANT AND TIMELY FOR YOU.

CLICK HERE TO SEE A LIST OF INVALID E-MAIL ADDRESSES THAT WERE REJECTED DURING THE RECENT MASS E-MAIL SENT OUT WITH PERTINENT INFORMATION THAT THESE PEOPLE DID NOT RECEIVE. PLEASE CHECK TO SEE IF YOU ON ARE THE LIST AND PLEASE MAKE CORRECTIONS.

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GMLSRC ENROLLMENT//DUES//CHANGE FORM

NAME ________________________________________________ SPOUSE'S NAME: ____________________

ADDRESS __________________________________________________________________________________

CITY/ST/ZIP ______________________________________________________________________________

PHONE (____) ____________________ EMAIL _________________________________________________

RETIREMENT DATE (MM/YY)__________ DEPT __________________ LOC ________________________

SEASONAL ADDRESS __________________________________________ FROM __________ TO _________
(Example: FROM 01 TO 04)

CITY/STATE/ZIP ____________________________________________ PHONE (____) ________________

FOR ENROLLMENT OR ANNUAL DUES
SEND FORM AND CHECK TO:

GM Lansing Salaried Retirees Club
Attn: Membership Committee
P.O. Box 12255
LANSING, MI 48901-2255

3 YEARS
2 YEARS
1 YEAR

$30
$20
$10

Member # ________
(Office use Only)

CHANGES ONLY CAN BE E-MAIL TO: clubfeedback@gmlsrc.org
OR MAILED TO THE ABOVE ADDRESS


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