Retiree Computer & Technology In-Person Class - Tuesday, March 28, 2023

Personal Information

• * First Name:
• * Last Name:
• * Cell Phone:
• Phone:
• * Email Address:
• * Confirm Email Address:
• *

  Is this the personal email address you would like Local 1180 to keep on file for you to receive all future correspondence, including from the Benefits Office?

  • Yes
  • No
• If no, what is the personal email address you want Local 1180 to keep on file for all correspondence?
• * Address 1:
• Address 2:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• Please enter your Member ID number, which can be found on your prescription card (Ex: CWA1180123456) or the last four digits of your Social Security number.