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Today's Date:
__________________ |
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Social Security:
____________________ UA Card Number:
______________________ Local Number: _______ |
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Pipefitter: _____
Plumber: _____ Welder: _____
Applicant: _____ Apprentice: _____
Traveler: _____ |
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LAST NAME:
_________________________________ FIRST NAME:
__________________________________ |
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Street Address:
______________________________________________________________________________ |
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City/State/Zip:
_______________________________________________________________________________ |
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Home Telephone:
__________________________ Cell or Work
Phone: ______________________________ |
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DEPOSIT: $25.00
Check # ____________ Money Order ____
Cash ____ |
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Title of Training
Courses or Tests |
Dates |
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1. ___________________________________________ |
____________________________ |
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2. ___________________________________________ |
____________________________ |
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3. ___________________________________________ |
____________________________ |
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Click your browser's Print
button to print this Form.
Mail this Form and the $25 Deposit
to......
Local 412 Training Center - Classes
Registration
411 Arizona SE, Albuquerque, NM 87108
