PARC MEMBER INFORMATION
New members, or for changes, please complete
First Name/Middle Initial Last Name
City ______ State Zip Code ____________
Home Telephone _______________________ Cell Phone _____________________________
Email Address _______________________________________________________________
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: email@example.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.