This form is used in conjunction with the Membership Dues Report to notify the International of changes in name, address and Social Security number only.

If the International received dues and other personal information from the employer via magnetic media, the employee should first report personal information changes to the employer who will then report them to the International.

If the change is not reflected on the Membership dues Report within sixty (60) days, it should be reported to the International on this form.

If the company reports to the International manually, the Local may report changes of other information such as work location or department through a letter or a copy of the Membership Dues Report with the changes indicated.

To help you identify addresses that need correction on the Membership Dues Report, an asterisk (*) will appear in the first position preceding the street address for those individuals who have an invalid address or no address on file.