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MDC/BOEING SAGES RETIREES CLUB

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APPLICATION FORM

INCLUDE A CHECK MADE OUT TO:
MDC/BOEING SAGES RETIREES CLUB
FOR $12 IF YOU ARE JOINING BETWEEN APRIL 1ST AND NOVEMBER 30TH. OTHERWISE THE CHECK SHOULD BE FOR $6.
_____________________________________

________________________________________
Last name         First name          Middle Initial
 
 
_______________________________________
Street Address
 
 
_____________________________________
City                 State                  (9) ZIP Code
 
 
________________________________________
Telephone No. (10) dig  Spouse First   Middle
                                        Name       Inital
 
 
_______________________________________
Date         Date          Last           Badge
Hired        Retired      Dept. #      Number
 
 
Mail form and check to:
    NDC/BOEING SAGES RETIREES CLUB
    P. O. BOX 2
    ST. ANN, MO 63074-0002
 
 
 
 
 
 
 
 

                  form  9/4/2004