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:
