Labor Assistance Professionals

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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.