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GM LANSING SALARIED RETIREES CLUB
NEW ENROLLMENT // DUES PAYMENT // CHANGE OF ADDRESS/E-MAIL
NAME:
___________________________________________________________________
ADDRESS:
_______________________________________________________________
CITY/STATE/ZIP:
___________________________________________________________
TELEPHONE: (____) ________________ E-MAIL:
_________________________________
RETIREMENT DATE: _______________ SPOUSE'S NAME:
_________________________
SECONDARY ADDRESS
SEASONAL ADDRESS:
_____________________________________________________
CITY #2: ______________________________ ST:
#2 _____ ZIP: #2 ___________________
TELEPHONE #2 (____) _______________________
SELECT ENROLLMENT PERIOD:
1 YEAR ___ $10.00
2 YEAR ___ $20.00 3
YEAR ___ $30.00
MEMBER #: _____________
(Office use only) |
SEND FORM AND CHECK TO: |
GMLRSC |
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FOR CHANGES ONLY
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P.O. BOX 12255
LANSING, MI 48901-2255
E-MAIL TO:
CLUBFEEDBACK@GMLSRC.ORG |
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