PARC MEMBER INFORMATION
   New members, please complete

Current members, please complete & return ONLY if you have CHANGES 

First Name/Middle Initial                                           Last Name                                         
Address                                                                                                                                  
City                             ______            State                                        Zip Code         ____________
Telephone                                                                                                                              
Your Membership Status (check one)                               Retiree          
                                                                                             Surviving Spouse/Domestic Partner

Spouse/Domestic Partner Name                                             __________________________

Spouse/Domestic Partner an Alcoan?                       Yes                  No

Email Address: _______________________________________________________________

How would you like to receive communications?   __________ Email

                                                                      or __________  USPS

 Optional Data:

Primary Occupational Specialty                                                                                           
Secondary Occupational Specialty                                                                                       

PARC Volunteer Interest: 
Yes, I would like to volunteer in the              ______ No, I cannot
following area(s):                                                       volunteer at this time.
            _______ Board
            _______ Officer
            _______ Appointed position ( Auditor,  Membership,  Newsletter,  Program Committee,  Website,  Entertainment/Cultural) (circle interests)

 
If you have any questions please contact Linda Hurteau or e-mail
 pghparc@hotmail.com

Note:  This data will be used for PARC information purposes only and will not be distributed for any other purpose.