University of Idaho Federation of Teachers
(Local 3215 American Federation of Teachers AFL-CIO)
PO Box 3127 Moscow ID 83843-1906
E-mail: dickow@uidaho.edu
Robert Dickow, Treasurer, Hampton School of Music, Campus 4015
Web site: http://www.uidaho.edu/aft
Application for membership (Please print or type) I hereby apply for membership in the University of Idaho Federation of
Teachers and its affiliates. I have read the Internal Revenue Service ruling
above.
Name (print) Dept.
Mailing address E-mail address
Annual salary Academic or Fiscal year
Payroll deduction? If so, Social Security Number
Signature Date