PARC MEMBER INFORMATION

New members, or for changes, please complete

First Name/Middle Initial Last Name

Address

City ______ State Zip Code ____________

Home Telephone _______________________ Cell Phone _____________________________

Email Address _______________________________________________________________

Retirement date___________________________________

Your email address will be the primary method of PARC communication.

Your Membership Status (check one) Retiree

Surviving Spouse/Domestic Partner

Spouse/Domestic Partner Name __________________________

Spouse/Domestic Partner an Alcoan? Yes No

PARC Volunteer Interest: Yes, I would like to volunteer in one of the following areas: _______ Officer

_______ Appointed position (Auditor, Membership, Newsletter, Program committee, Website, Entertainment/Cultural (circle interests)

Return form to: parcmembership1888@gmail.com. If you have any questions, contact Sue Zemba at 412-360-9216 (leave a vmx) or at this listed email address.

Note: This data will be used for PARC information purposes only and will not

be distributed for any other purpose.