Labor Assistance Professionals

Please Note: If a requested field of informtion does not apply to you, enter N/A (not applicable). All fields must contain required information or N/A. Otherwise, the form will not submit.

A copy of this form will automatically be sent to the email address listed on the form. If you do not receive it, check your spam folder.

If the form fails to submit due to missing information, use your browser back button to return to the form, and enter the missing information.

When the form is submitted, you will then see payment information and directions for making an online credit, personal check or money order payment transaction.

Note: The school tuition fee is $1800.00. However, online payment with a credit card will incur an additional processing fee. To avoid the added credit card fee, when you submit the registration form, consider mailing a check instead.

The contact persons for all questions regarding the school are Tyrone Brown, (980) 238-9696 or tyrone.brown@daimlertruck.com.

Identification Information

Last Name:

First Name:

Nickname::

Email Address:

LAP Chapter:

Personal Contact Information

Street Address::

City, State, Zip:

Home Phone: or Cell:

Home Fax:

Union & Work Information

Union Name:

Union Local, District, Council, Etc. Name:

Union Position or Title:

Work Address:

City, State, Zip:

Work Phone:

Work Fax:

Education Information

High School Name or G.E.D.:

H.S. Graduation Date:

Fee Payment Method

Enter First and Last Name of Person
on the Credit Card, Check, or Money
Order being uUsed for Payjment

Today/s Date:

Signature:

Use your mouse, finger, or touch device to write your signature.