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ACTIVE MEMBER REGISTRATION
Complete this page and mail, with the appropriate Annual Dues, to J.E.Hills, Treasurer, DIPAC 303-1903 Pilgrims Way Oakville, ON L6M 2X1
Renewal Registrations should only include your name and any changes in other information since last registration. Please Print Name:………………………………………………….. Address:……………………………………………….. City:…………………………..Province……………… Postal Code:…………………… Phone: (…….)……………………. Fax; (……..)………………………. e-mail:……………………………………. Year of Retirement:………….. Location at Retirement:………………………… New Registration…………….. Renewal Registration………………… Survivorship At retirement, did you elect to leave a Joint & Survivor pension payable to your spouse upon your death? Forms would have been signed…. (1) which specified the pension to be paid, or…(2) a waiver if none was the case. To facilitate continuing contact by DIPAC, if a pension was to be paid, please provide us with: The annual membership fee for 2011 is $10; Lifetime membership fee is $150. 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. 16 April 2011 |
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