Group Membership Application

Application for Membership
The TelecomPioneers invites you to join us in the largest industry related volunteer organization in the world with over 500,000 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
Employee ID #	*
Work Phone		Work Address
Work City		Work StateZip Code
Last 4 digits of Social Security Number	*
If you do not know your chapter, you will be assigned geographically by your work location.
Chapter

This is to authorize Verizon Communications 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.

Security Code	*