New Local Presidents’ Training Registration - AFGE National VA Council

1970 Roanoke Blvd Building 76 Suite 106 Salem, VA 24153 Phone: 540-345-6301 Fax: 540-342-2196

dbrauch@

AFGE National VA Council

New Local Presidents' Training Registration

Please complete all information as accurately as possible. *NOTE: This information will be used to share internal union business. Please fill out and email this form to Training & Education Secretary Debby Brauch, at dbrauch@ , or fax to the number above, 540-342-2196.

Local Number

Local email

Are you still located within a

VA facility?

Local Address

Local Phone Number

Local Fax Number

Please fill out all Local information Date completed ____/____/_____ Mo / day/ year

Last name, first & middle name

Private (non Government

.gov) email

email

Home Address

Cell Number Home Number

Local District & VISN #s

(if known)

Date Elected

*Form updated 5/10/2022

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