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PSC MEMBERSHIP UPDATE FORM
FOR RETIREES
 

 

Please print the form.  Complete it and send to:

Professional Staff Congress
61 Broadway, 15th Floor
New York, NY 10006
   ATT:  Diana Rosato/ Membership Coordinator

NAME

First Name __________________________________Middle Name _______________________

Last name ____________________________________________________________________

HOME ADDRESS

Number and street ______________________________________________________________

Town/city _______________________________________State and ZIP ___________________

PHONE

Home Phone _____________________________Cell Phone __________________________

COLLEGE THAT EMPLOYED YOU:

College ______________________________________________________________________

EMAIL 

Email address _________________________________________________________________

RETIREMENT DATE:

Date retired__________________________________________

The PSC does not sell its membership email or phone lists or distribute them to third parties.
Communication with members is done with respect for privacy.