Teamsters Local 492

Return to Membership Application

Return To Membership Application

Please fill out the form in its entirety as soon as you start back to work to avoid back dues payment.

First Name and Middle Initial:
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Last Name:
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Address:
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City, State:
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Postal Code:
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Phone:
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E-Mail Address:

Last Four SS#

Employer & Location

Date Withdrawal Card Was Issued by 492 (If you can't remember, put your best guess)

Date You Returned to Work

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