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Type
of application: NEW ______
RENEWAL _______
I,
________________________________________ hereby apply for membership in the
Georgia State AFL-CIO Minority Caucus.
I agree to pay the sum of $15.00 annually as dues.
NAME
__________________________________________________________________________
ADDRESS
_______________________________________________________________________
CITY__________________________________
STATE ________________ ZIP _______________
HOME
TELEPHONE # _______________________ WORK TELEPHONE # ___________________
E-MAIL
ADDRESS ________________________________________________________________
UNION
__________________________________ LOCAL # __________ DISTRICT # __________
LOCAL
ADDRESS ________________________________________________________________
TELEPHONE
#_____________________ POSITION HELD _________________________________
___________________________________________________
DATE _____________________
(SIGNATURE OF APPLICANT)
_____
WISH TO APPEAR IN MEMBERSHIP DIRECTORY.
_____
DO NOT WISH TO APPEAR IN MEMBERSHIP DIRECTORY.
Please
mail form and check to:
DENISE MAYES, TREASURER
GEORGIA STATE AFL-CIO
MINORITY CAUCUS
501 PULLIAM STREET SW SUITE 517
ATLANTA, GA 30312
APPLICATION
RECEIVED BY
__________________________________________________________________________________
(NAME)
(TITLE)
(DATE)
APPROVED
BY
______________________________________________________________________________________________
(NAME)
(TITLE)
(DATE)
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