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 - 2008   United Association Local Union No. 412    All Rights Reserved.