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:


    City: State Zip

    Phone: #


    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: