ORGANIZING LEAD

(PLEASE PRINT OR TYPE)

NAME: ____________________________________________________________

ADDRESS:_________________________________________________________

                   _________________________________________________________

CITY: _____________________________ STATE: ________ZIP:_____________

PHONE: ( ______ ) _______ - _____________

BEST TIME TO CONTACT___________________________________________

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EMPLOYER:________________________________________________________

ADDRESS: _________________________________________________________

CITY: _____________________________ STATE: _______ ZIP:______________

NUMBER OF EMPLOYEES: __________ NUMBER OF SHIFTS: __________

USE BACK SIDE FOR ADDITIONAL COMMENTS.

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PRINT USING YOUR SYSTEMS PRINT FUNCTION AND FILL IN:

To send this form by fax or postal mail  to IAM District 121 by mail please write to:
 

Main Office

IAM District 121
Office:  107 Warren Street
 Beaver Dam, WI                53916

Phone:                920-885-4239
Fax:                    920-885-4483
Toll Free:          866-636-4239

e-mail: iamdl121@sbcglobal.net