IFPTE Local 4

New Membership Application Card

Please print this page, complete form, and submit with your completed SF-1187. Please use the "SUBMITTED BY" block to designate your Member Sponsor.

All New Members Receive a New Member Gift Packet

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IFPTE LOCAL 4 - MEMBERSHIP APPLICATION FORM 

I hereby make application to become a member of LOCAL-4, and affiliate of the International Federation of Professional and Technical Engineers, AFL-CIO.

Name: ___________________________ Home Phone: ______________

Address:____________________________________________________

City: __________________________ State: ___________ Zip: _______

Badge #: __________ Home email: _____________________________

Code #:___________ Work phone: ______________________________

Date of Birth: _____________ Date of Application: ________________

Applicant’s Signature: ________________________________________

Submitted by (please print):____________________________________

FOR OFFICIAL USE ONLY - PRIVACY SENSITIVE: ANY MISUSE OR UNAUTHORIZED DISCLOSURE MAY RESULT IN BOTH CIVIL AND CRIMINAL PENALTIES.

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