Local 983 Membership Meeting & Holiday Party - December 7

PERSONAL INFORMATION: All sections MUST be completed. Email MUST be a personal email address.

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Address 1:
• Address 2:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Cell Phone:
• * Last four digits of Social Security number

WORK INFORMATION:

• * Job Title:
• * Agency:
• Department:
• Phone:

UNION INFORMATION

• *

  Are you a dues-paying member of Local 983?

  • Yes
  • No
• *

  Have you filled out an updated Local 983 membership form within the last two years?

  • Yes
  • No
  • Not Sure
• If you answered "No" or "Not Sure" to the above question, what is the best phone number to reach you at so we can arrange for you to sign an updated card?

Guest Information

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