Scranton Federation Of Teachers Local 1147

A.C. Moore Discount Application Form

A.C. Moore 500 University Avenue

Blackwood, New Jersey 08012

Dear Diane,

Please send me an A.C. Moore Discount Card.

Below is the information you requested.

Personal Information:

Name____________________________

Phone Number (570)-___________

Street Address__________________________________________________

City_________________________ State__________ Zip Code___________

Scranton School District Information:

Building Assignment_____________________________________________

Address ______________________________Scranton, PA

_________________ (Zip Code)

Principal____________________________

Bld. Phone (570)-____________

I have enclosed a copy of my union card as requested.

Thank you,

_______________________________________ (Signature of teacher)