On Line Affiliation Form

Please complete and submitt the form below:

Local Union Information

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
URL

Today's Date

-- mm/dd/yy

Starting Affiliation Date:

-- mm/dd/yy

To:

-- mm/dd/yy

Number of Members

  X $.75 X Number of Months =  Amount Paid:

Officer to receive correspondence:

Name
Title
Work Phone
Home Phone
FAX
E-mail
URL

Please make check payable to Georgia AFL-CIO and mail check to

Charlie Key, Secretary Treasurer

Georgia AFL-CIO

501 Pulliam St., SW Suite 549

Atlanta, GA 30312

Author information goes here.
Copyright © 1999 [OrganizationName]. All rights reserved.
Revised: 01/02/08