AFGE District 3

September 07, 2010

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New User Registration!

Please fill this form out to the best of your ability, remembering that fields marked with an asterick are required in order for the form to be submitted. You can obtain an @afgedistrict3.org email address. Choose your username and password for the email address and one will be created for you. Once you are registered with the site, there will be an "email login" button on the home page where you can log in your email address and get your emails. If you have any questions, you may call the district office at (570) 883-9572.

First Name:	*
Last Name:	*
Address:
City, State/Province:	,
Postal Code:	-
County:
Country:
Phone:
Cell Phone:	Format (no spaces or dashes): xxxxxxxxxx Select Your Cell Phone Provider: Send Me Text Message Alerts:
E-Mail Address:	* Allow other members to view my email address
LOCAL #:	*

Member # :

Choose Username:	* (DO NOT use spaces)
Choose Password:	* (DO NOT use spaces)

Do you need email @afgedistrict3.org?	(Select Yes to have an email address created for you @afgedistrict3.org using the username and password you specified above.)
	Click the Preview button below to review the registration information on the next page. * Required Fields