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MEMBERSHIP APPLICATION / RENEWAL FORM (FOR 2008 AND BEYOND)
EXXONMOBIL ANNUITANT CLUB OF THE MORRIS AREA
EACMA is open to ExxonMobil retirees and their spouses.
Additional information about membership eligibility may be found by going to
www.eacma.org and clicking on the By-Laws link in the left margin.
New Members fee is $10 per
person (= $20 per couple). Renewing Members fee is also $10 per person (= $20 per couple),
if renewed before the start of the renewed year. Membership renewals sent after
December 31 are at DOUBLE RATES (i.e. $20/person = $40/couple) because ExxonMobil does not subsidize us for late renewals. Please complete this application and return to Doris Harris. If you have questions, please call Doris Harris on 973-887-5108 or email her at
membershipchair@eacma.org.
TO: Doris Haris, 34 Adams Drive, Whippany, NJ 07981-2051
Enclosed is my Check No. _______ payable to EACMA for $___________
to cover - - - - - - ___ one or ___ two memberships as follows:
Annuitant ________________________ Spouse __________________________
Email address (if you have one) ________________________________________
(
Please provide email address even if it has not changed since your last year.)
Membership Type ___ Regular Member **___ Associate Member
** NOTE: If you check "Regular
Member", then you are designating the EXXONMOBIL ANNUITANT CLUB OF THE MORRIS AREA (also known as EACMA) as your primary Annuitant Club thus allowing us to benefit from ExxonMobil's subsidy. Alternatively, if you choose another Annuitant Club as your primary club, then please check "Associate
Member." Because your other club will receive the subsidy, you will be subject
to slightly higher fees for EACMA luncheons and activities.
How would you like to receive our newsletters? (ONE CHOICE ONLY, PLEASE)
___ Paper copy by ordinary US mail
___ Electronic (If you select this, then we will send you an email with the newsletter attached. That same email will also contain a link to our website where the same newsletter will be posted.).
The club strongly encourages the Electronic option if you have the capability. U.S. mail is expensive and labor-intensive to print, collate, label, and mail.
Email may be sent to both the annuitant and the spouse.
If you want both, then please list the second email address here: _________________________
___ I might be interested in
serving in a Club Office in the future. Offices / committees of possible
interest include __________________________________________. Please have someone contact me.
NEW MEMBERS ONLY (others use
ONLY if there are changes):
PHONE: ( ________ ) _________ - ____________________
MAILING ADDRESS: ___________________________________________________
___________________________________________________
Please provide Social Security Number(s) (SSN's) and retirement information below for use by ExxonMobil Annuitant Affairs, Houston:
Annuitant SSN ______/______/_______ Retirement Date ___________________
Retired from (name of ExxonMobil Origination) ____________________________
Spouse SSN _____/_____/______ Or Surviving Spouse SSN _____/____/______
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