FORM
Red River United AFT Local 4995
Representing Bossier, Caddo, and Red River Parishes

Affiliated with the-AFT 

13'26 Line Avenue, Shreveport, LA 71101
Phone: 313-42445?9

Fax: 318-424?4593

Email: 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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An?rsanizadoll meanwhile 
i Employee ID Number or
Last 4 digits of Social
Ham 
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Last Name: SchooUSiiJe Name:

Previous Name: Job Positionf?esa'ip?on:
Billing Address: Cell Phone:
Billing City: I Home Phone:
Billing State: school Email:
Billing Zip: - l?on-Work' Email:

1
Billing address is [also my home addrea YES, I wish to receive text messaging W1
?Parish: Bossieri caoee Red River Charter Private other: 
3 Position: Teadwericera?ed SupporUCiassl?ed Student Teacher Substitute Teacher Either:
Recruiter (if applicat?ie}: 

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fud?alhoomoiespormme; 

I agree to he a mem?er of Red River united, Local 4995, authorize Red River United, Local 4995 to represent me
to the fullest extent of the law, and aeoept the terms?of the agreement above.




I would like In?: dues to be collected via (check. one):

Payroll Deduction ACH Bank Draft

Signature . Date

  

   
  

 

 

 

HillJ or the portion below outreyou would like your dues to be collected via book drofc__

 

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Checking Saving

. Bank Routing
Number (9 digits):

 

 

 

Bank Account Nominal-z

 

1