Don't forget to notify GMLSRC of any new address or telephone number or E-Mail changes so that we can keep your newsletters coming to you in an orderly manner.

Use the handy form below for changes:

GM LANSING SALARIED RETIREES CLUB
NEW ENROLLMENT / DUES PAYMENT / CHANGE OF ADDRESS/CHANGE OF E-MAIL

NAME: ___________________________________________________________________

ADDRESS: _______________________________________________________________

CITY/STATE/ZIP: ___________________________________________________________

TELEPHONE: (____) ________________ E-MAIL: _________________________________

RETIREMENT DATE: _______________ SPOUSE'S NAME: _________________________

SECONDARY ADDRESS

ADDRESS #2: _____________________________________________________________

CITY/STATE/ZIP #2: _________________________________________________________

TELEPHONE #2 (____) _______________________

DATES AT SECONDARY ADDRESS:        FROM MONTH _____      TO MONTH _____

SELECT ENROLLMENT PERIOD:

                    1 YEAR ___ $10.00           2 YEAR ___ $20.00        3 YEAR ___ $30.00

MEMBER #: _____________