ACTIVE MEMBER REGISTRATION
DuPont/INVISTA Pensioners Association-Canada
Complete this page and mail, with the appropriate Annual Dues, to J.E.Hills, Treasurer, DIPAC 303-1903 Pilgrims Way Oakville, ON L6M 2X1 Please Print
Name: ......................................................................................................
Address: ...................................................................................................
City: ......................................................................... Province ..................
Postal Code: ...................................
Phone: (.......) ......................... Fax; (........) ............................
e-mail: ........................................... If Survivorship Option was selected at Retirement, please indicate:
Name of Spouse: .................. Year of Retirement:.............. Location at Retirement:................................. New Registration......... Renewal Registration........ The annual membership fee for 2010 is $10 Please forward your registration and dues at the earliest opportunity. Please make cheques payable to: DuPont/INVISTA Pensioners Association-Canada. It continues to be ‘cost prohibitive' to provide for dues remittance via the Internet & our web site.
Note: Renewal Registrations need only include your name and any changes in other information since last registration. If you have Registered Online, you need only fill in your name
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