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 * Choose one-- Regular (still working) Life (retired) Associate (Spouse/Partner) Affiliate First Name * Middle Initial: Last Name* Address * City * State*- - Choose One - - Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Home Phone Work Phone Last 4 digits of Social Security Number* Home email address Work email address This is to authorize FairPoint Communications and any FairPoint subsidiary or entity by which I may hereafter be employed to make payroll deductions for the payment of FairPoint 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 *