Member Registration

Registration Form

Name *

First Name

Middle Initial

Last Name

Occupation/Job Title *

Employer *

Local Union # *

Home Address*

Street Address

Apt #

City

State

Zipcode

Phone *

Home Phone

Mobile Phone

Work Phone

Email and ID Number

Email*

This will also be your user name

AFSCME I.D. Number *

If you do not have a number, call AFSCME Membership Dept at (517)-487-5081 or (800)-AFSCME 25 (800-237-2632)

Password*

Confirm Password*