MBHS UFT Chapter Member Registration

All information will be kept confidential with the chapter leader.

First Name:
Last Name:
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Department: other:
Position:
File No: (optional)
Year you entered the system (BOE)
Year you came to Bergtraum
e-Mail: (primary)
e-Mail: (secondary)
Mobile Telephone: (optional)
Home Telephone: (optional)
Comp-Time Position:
Year Started Comp-Time
Circular 6 Assignment
Year Assigned Circular 6
Are you tenured? Yes No, If "no", when do you expect to be tenured? Semester: Year:
Comment/Question: