
6
PCIG -- MEMBERSHIP APPLICATION / CHANGE OF ADDRESS FORM
Members at the June 2005 PCIG meeting voted to eliminate dues effective immediately
for one year! To register as a member just email our secretary Aaron Albertson
n1driver@charter.net, send in this form, or sign yourself up for our monthly newsletter
on topica by following this link: topicalink <http://www.topica.com/subscribe/pcig>
If this is a new membership application, please enter the name of the person who referred you to
PCIG ______________________________
EMPLOYEE NAME: _________________________________________________
EMPLOYEE STATUS (circle one) Regular(full time) Retired
IBM Dept: ________ BDLG: ________
Internal/External Email address: _______________________________
Home Address:
___________________________________________
___________________________________________
___________________________________________
Home Phone: _____________ Work Phone: _____________
To qualify as an Associate Member, dependents *MUST* qualify for benefits under the IBM
Medical Benefits Plan.
Associate Members:
___________________________________________
___________________________________________
PLEASE SEND COMPLETED FORM:
IBM PCIG SECRETARY
H371
Bldg 0402
3605 NW Hwy 52
Rochester, MN 55901
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