After filling out this form, please send your check to the SNET Retirees Association at: 318 Central Road • Middlebury, CT 06762

If you prefer to print and mail this form click here

Check One: New MemberRenewal

Your First and Last Name:

Address:

City: State Zip

Phone: #

Email:

Alternate/Vacation Address and Phone # (Please include dates you will be at your alternate address):

Retired From: SNETCingularSBCAT&T

Year Retired:

Stockowner? YesNo

Dues are $15. My additional contribution is:

Total: