UPSEU LOCAL 1222 CHANGE OF ADDRESS NOTIFICATION*
Member Name
__________________________________________________________
SS# _______________________________________
Old Address
Street _________________________________________________________________
City, State, Zip __________________________________________________________
New Address
Street _________________________________________________________________
City, State, Zip
__________________________________________________________
Phone # _____________________________________________________________
Signature
__________________________________
Date _____________________
Return To:
United Professional
& Service Employees
Local 1222
Suite H