Change of Address

First Name

Last Name

Employee Number

Please enter your 6-digit Employee Number.

Local #

Personal Email

Previous address

Street Address

Apartment, Suite, etc.

City

State

ZIP/Postal Code

New Address

Street Address

Apartment, Suite, etc.

City

State

ZIP/Postal Code

Authorization & Signature Confirmation

I, the undersigned, hereby authorize representatives of RI Council 94 to make the necessary adjustments to my information on file so that it reflects the updated information contained herein.

By signing below, I agree that my electronic signature is a binding and valid signature and represents that I am the person to which the information herein pertains to and that the information is correct and accurate.

Signature

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Change of Address