Name Change Form

Name on File

Enter name that is currently on file with RI Council 94.

New Name

Enter name as it now appears on official government documents

Street Address

Apartment, Suite, etc.

City

State

ZIP/Postal Code

Local #:

Employer

Authorization & Signature Confirmation

I, the undersigned, hereby authorize representatives of RI Council 94 to make the necessary adjustments to my information on file so that it reflects the updated information contained herein.  

By signing below, I agree that my electronic signature is a binding and valid signature and represents that I am the person to which the information herein pertains to and that the information is correct and accurate.

Signature

Sign above