REGISTRATION FORM FOR TRAINING COURCES And TESTS

   Today's Date: __________________  
 Social Security: __________________   UA Card Number: _________________  Local Number: ______
 Pipefitter: ____  Plumber: ____   Welder: ____   Applicant: ____  Apprentice: ____  Traveler: _____
 LAST NAME: ____________________________  FIRST NAME: ____________________________
 Street Address: ____________________________________________________________________
 City/State/Zip: _____________________________________________________________________
 Home Telephone: ________________________    Cell or Work Phone: ______________________
 DEPOSIT: $25.00     Check # ____________    Money Order ____    Cash ____
 

Title of Training Courses or Tests

Dates

 1. ___________________________________________   ____________________________
 2. ___________________________________________   ____________________________
 3. ___________________________________________   ____________________________
   

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Mail this Form and the $25 Deposit to......

Local 412 Training Center - Classes Registration

411 Arizona SE, Albuquerque, NM 87108

 

Phone: 256-9257

©2004 - 2011   United Association Local Union No. 412    All Rights Reserved.