LUCENT RETIREES ORGANIZATION (LRO) 

Please support LRO endeavors by enclosing YOUR annual membership donation of $25, or a lifetime donation of $350.

First Name _________________ MI ____ Last Name _________________ 

Street _______________________________________________________ 

City ___________________________________ State _________________ 

ZIP or Postal Code _________________         Country _________________ 

Telephone _________________      E-mail ___________________________
                                                             
Status:   [ ] Retired   [ ] Active    [ ]Spouse      [ ] Terminated, vested     
Year of Retirement ________       [ ] Management        [ ] Non-management 

Company Retired From_________________________  Years of Service _____ 

I would like to volunteer support for:            I first became aware of LRO through: 

[  ]Data base administration                           [  ] a friend
[  ]Legal counsel                                           [  ] a former co-worker
[  ]Accounting and Finance                            [  ] the LRO website
[  ]Executive contacts                                   [  ] a news article
[  ]LRO leadership                                        [  ] pioneer/retiree clubs
[  ]Newsletter editing                                    [  ] credit union publication ad
[  ]Issues identification                                  [  ] union meeting
[  ]Media relations                                        [  ] lucent news or letter
                                                                      [  ] other: please specify __________________________________

 I do not wish to share my name and address info with other members [ ].

Please mail your completed form and membership donation to your Regional Head as shown in the table of Regional Offices. Or mail to  
 LRO Inc.
      % P O Box 1535
         Cranford, N.J. 07016

The LRO is a not for profit, tax exempt organization; dues or contributions submitted by members are not tax deductible