Members' change of address and status form

Fill out the following form to change your address and status.

First Name: *

Last Name: *

Middle Name:

Other (i.e. nickname):

Date of Birth:

Gender (optional):

Male

Female

Member Contact Information

Address: *

City: *

Province: *

Postal Code: *

Phone Home:

Cell:

Home Email:

Phone Work:

Work Cell:

Work Email:

Job Information (If more than one job, please submit the form twice)

Employer: *

Building Name:

Building Address:

City: *

Province: *

Postal Code:

Job Title:

Local #:

Job End Date:

Job Start Date:

Job Type:

Full Time

Part time

Casual

Sub Type:

Perm

Temp

Seasonal

Comments:

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