Application for Membership

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.

If you choose to pay by check or cash, please click here to print out a member application.

Member Type (check one): Regular (still working): Life (retired): Associate (Spouse/Partner) Affiliate

PLEASE NOTE: those areas with an * must be filled in.

*First Name:

Middle Initial:

*Last Name:


*Address:
*City:	*State:	*Zipcode:

Home Phone:		Work Address:

City:		State:		Zipcode:

Work Phone:		Cell Phone*:		*Last 4 digits of SSN:
E-Mail:		E-Mail*:		* Optional

Chapter		If you do not know your chapter, you will be contacted and assigned geographically by your home town or work location.

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 TelecomPioneer dues. Annual dues are $15.00, currently being taken at $1.25 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.

INTERESTS AND SKILLS 1. Please indicate the types of programs in which you would be interested.

Education/Literacy	Homeless		Soup Kitchens/Food Pantry
Elderly	Hug-A-Bears		Special Events
Environmental	Mentally/Physically Challenged		911 Simulator
Dictionary Project	Playground MAP		Officer or Chairperson
Fundraising	Project Connect
Heart Pillows	Smart Bears		Other
		If "Other", please specify below;



2. Please check or list below any skills/talents you would like to contribute as a volunteer:
Artist	Bi-Lingual	Carpentry
Ceramics	Specify	Clerical/Secretarial
Clowning	Computer	Cooking/Baking
Crafts	Programing	Disaster Relief
Electrical	Data Entry	Fitness/Exercise
Gardening	Music	Nutrition/Health
Photography	Plumbing	Project Leadership
Quilting	Sewing	Signing
Sports	Theater	Tutoring
Wallpaper/Painting	Writing	Specify
	Others
	Specify
3. I prefer volunteer activities:
Before work	Lunch Time	After Work
Saturday	Sunday	Weekends

You may need to wait several seconds after clicking "Submit" below before you receive confirmation.