NATIONAL ALUMNI CLUB

MEMBERSHIP APPLICATION

H.C.S.C. Alumni Club, Inc.

National Club Application

(Please print)

Application Date: __________________

Name: _________________________________________________DOB_______________

Spouse’s name: ____________________________________________________________

Address:  __________________________________________________________________

City:  ____________________________________ State: _______ Zip code: ___________

Phone: ____________________________________________________________________

Cell Phone: ________________________________________________________________

E-mail address: _____________________________________________________________

Date started with JCPenney: ___________________________________________________

Date retired/resigned from JCPenney: __________________________________________

Last assignment:  ___________________________________________________________

Last location: _______________________________________________________________

Regional Meeting Group(s) I want to join: __________________________________________

_________________________________________________________________________________________

(Dues for the National Club are waived for the first calendar year.)

You will be billed the Annual Membership fee, currently $25, each year

thereafter. Dues for the Regional Meeting Groups can be found on the

website  www.jcpalumniclub.org

Mail application form to:

National H.C.S.C. Alumni Club

P O Box 261978

Plano, TX 75026-1978

Or e-mail to natclubsecretary@gmail.com

More information can be found on the Club's website,

www.jcpalumniclub.org .