West Virginia Membership Application

Application for Membership

The TelecomPioneers invites you to join us in the largest industry related volunteer organization in the world with over 625,000 members in North America.

Did a Pioneer refer you?If so, who

Member Type

First Name

Middle Initial: Last Name*

Home Phone

Home Address*

Home City

Home State*Zip Code

Home email address

Service Date

Birthdate*

Work Phone

Work Address

Work City

Work State*Zip Code

Work email address

Last 4 digits of Social Security Number

Are you interested in any of the following projects:

Becoming an officer	Educational projects
Environmental projects	Fundraising
Sewing projects; heart pillows or hug a bears

Do you have a specific talent you would like to share?

This is to authorize Verizon Inc. and any Verizon subsidiary or entity by which I may hereafter be employed to make payroll deductions for the payment of Verizon Pioneer dues. Annual dues are $22.00, currently being taken at $1.83 per month. These funds help offset the cost of certain organizational activities including start-up costs for new community service projects. Dues are non-refundable.

Please enter the "security code" and then click on "submit form". The "security code" is used to protect a form from spam bots. By encoding a "security code"' inside an image and asking you to re-enter what you see I can verify you are a human and not automated software submitting the form.

Security Code