LUCENT RETIREES ORGANIZATION (LRO) 

Please support LRO endeavors by enclosing YOUR annual membership donation of $25, five-year payment for $100, or a lifetime donation of $350.

First Name _________________ MI ____ Last Name _________________ 

Street _______________________________________________________ 

City ___________________________________ State _________________ 

ZIP or Postal Code _________________         Country _________________ 

Telephone _________________      E-mail ___________________________
                                                             
Status:   [ ] Retired   [ ] Active    [ ]Spouse      [ ] Terminated, vested     
Year of Retirement ________       [ ] Management        [ ] Non-management 

Company Retired From_________________________  Years of Service _____ 

I would like to volunteer support for:            I first became aware of LRO through: 

[  ]Data base administration                           [  ] a friend
[  ]Legal counsel                                           [  ] a former co-worker
[  ]Accounting and Finance                            [  ] the LRO website
[  ]Executive contacts                                   [  ] a news article
[  ]LRO leadership                                        [  ] pioneer/retiree clubs
[  ]Newsletter editing                                    [  ] credit union publication ad
[  ]Issues identification                                  [  ] union meeting
[  ]Media relations                                        [  ] lucent news or letter
                                                                      [  ] other: please specify __________________________________

 I do not wish to share my name and address info with other members [ ].

Please mail your completed form and membership donation to your Regional Head as shown in the table of Regional Offices. Or mail to  
 
LRO Inc.
Financial Office
P.O. Box 816
Winter Haven, Fl. 33882


The LRO is a not for profit, tax exempt organization; dues or contributions submitted by members are not tax deductible