Staten Island Telco Retirees Club
Come join the Staten Island Telco Retirees
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Join the Staten Island Telco Retirees Club.
A CWA RMC chapter affiliated with Local 1102 Staten Island, NY

Print and fill out the form below and bring it to the next meeting.
 
Dues are $30.00 a year.

Last Name _________________________________
 
First Name _________________________________
 
 
Street  ____________________________________
 
 
City __________________State ________ Zip _______
 
 
email address _________________________________
 
Home Phone ______________________________
 
Cell Phone ________________________________
 
Birthday  Mo ______  Day _______
 
Spouse's name ______________________________
 
Company you retired from _____________________________