Post No: _______  Transmittal No:________   Card Year: ________

Below is a list of renewals/new members whose records are being paid on the transmittal number listed above, which is included with this form and membership cards. I understand this will be stapled to my transmittal slip at the time of processing and if there are any discrepancies, the Department will be able to use this sheet for easy assistance.

*Please retain a copy for your Post records and copies of this form must be made at the Post expense. This form is

                                                   optional and does not have to be used by the Post.*