Membership Change Form

Name: ________________________________________________________________

Address: ______________________________________________________________

City/Province: ______________________________ Postal Code: __________________

Email: ____________________________________ Telephone: ___________________

Place an X in the appropriate box/boxes:

[ ] New Name: _________________________________________________________

[ ] New Address: _______________________________________________________

City/Prov.: _____________________________ Postal Code: _________________

[ ] New Phone #: __________________________

[ ] New Email: ____________________________

Please send form to:

Saskatchewan Retirees Association

Walter Scott Building, 3085 Albert St.

Regina, SK S4S 0B1

Or email changes to: info@saskretirees.org

SRA002/2010