Mail Station (address if not current employee):________________________________________

      Telephone (extension):____________________ Hire Date:____________________ Employee #:____________________

      Social Security #:____________________ I am a Current Employee:_______ or Former Employee_______ or Retiree:_______

      If applying for Associate Member*_______please include Sponsoring Members Name__________________________

      and Membership Tie-in; spouse, customer, etc.___________________

      *An Associate Member can be anyone affiliated with Honeywell Inc.; adult family members of Honeywell employees or retirees,

      customer representatives, and those contracted to provide regular services within the Honeywell facility.

      Must be 21 years of age.  Annual dues are $20.00 for all members; excluding Retirees and Retiree's Spouses,

      these due are $10.00. Dues are payable in full upon approval of this application.

      and request that a $20.00 dues payment be deducted from my earnings (paid by Honeywell) in the last pay period of the last calendar

      month of the year as specified by the Minnreg Association, and that the amount so deducted be paid to the Treasure of the Minnreg

      Association. This authorization is revocable at any time by written notice by the individual to the Secretary of the Minnreg Association.

      I agree and direct that this authorization shall be automatically renewed for successive annual periods of one year from the last period

      in the last calendar month of each year so long as I remain an employee of Honeywell in this area.

      NAME:________________________________ DATE:_________________

      CHAIRMAN:____________________SECRETARY:_____________________________