New York Region Management Society

New York – New Jersey – Puerto Rico – Virgin Islands

Membership Application

I wish to become a member of the New York Region Social Security Management Society. Enclosed is Form SF-1187 authorizing payroll deductions. Inclusion of my home address will allow internal Management Society material to be sent to my home on occasion.

 

Name (print)             _________________________________________________________

Title                         _________________________________________________________

Date                         _________________________________________________________

Office Name             _________________________________________________________

Office Mailing Address ________________________________________________________

                                _________________________________________________________

Telephone                 _________________________________________________________

E-Mail                         ________________________________________________________

Home Address             ________________________________________________________

                                 ________________________________________________________

 

 

Please mail, e-mail or fax this application and a copy of the SF-1187 to:

Norma Lefebvre

C/O Social Security Administration

26 Federal Plaza

Room 40-140

New York, NY 10278

Fax: 212-264-0951

Please mail the original SF-1187 to:

Hal Golio

297 Knollwood Road
Suite 4A
White Plains, NY 10607-1845