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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
