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AFSCME 1368 Member Info

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First Name *
Last Name *
Email (Home) *
Street Address (Primary) *
Supplemental Address 1 (Primary)
City (Primary) *
Postal Code (Primary) *
State (Primary) *
Phone (Primary) *
Phone-Mobile (Primary)
Member Info: Employee ID
	Your Employee ID is your card number on your membership card. Do NOT include any prefixes, such as "ba." Numbers only. If you don't know or can't locate your card number, request it from the union office or call 508-816-9293. IF YOU ARE NOT A MEMBER, PLEASE LEAVE THIS FIELD BLANK.
Member Info: Are you a member? *	Yes No ( unselect )
Member Info: What's your interest in AFSCME 1368?
Email (Work)
Member Info: Work Location *
	Please indicate which DYS Location you are working at

Union Information