The Laboratory Retiree Group,Inc is comprised of retired Los Alamos National Laboratory employees, their spouses, and affiliates. An affiliate is a surviving spouse or a former spouse of a LANL employee who is eligible for UCRP or PERS benefits. Annual dues for a calendar year are $12.00 per household for both members and affiliates. Friends dues are $15.00.

(When entering names please put last name first.)

Lab. Retiree:_________________, __________________ Year Retired:______ UCRP:_______ PERS:________

Spouse:_____________________, ____________________ LANL Retiree? N__ Y__ Year Retired:____

Friend:_____________________, ___________________

Address:_______________________ City:_________________ State:___ Zip:________

Telephone:(____) _____________ Fax or E-mail: ______________________________

Please make your check, which will serve as your receipt, payable to LRG, Inc. and mail to:
        LRG, Inc., PO Box 546, Los Alamos, NM 87544

Check #: ______________ Date: _______________ Amount $: _____________________

I WISH TO BE LISTED IN THE LABORATORY RETIREE DIRECTORY: Y___ N___
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