DISTRICT 27  ORGANIZING LEAD

First Name:_________________________

Last Name:__________________________________

Address 1:_______________________________________________________________________

Address 2:_______________________________________________________________________

City: ______________________________________ State: ________Zip:_____________

Phone: ( ______ ) _______ - _________ FAX: ( ______ ) _______ - _________

E-mail___________________________________________________________

Employer:________________________________________________________

Work Address 1: _________________________________________________________________

Work Address 2: _________________________________________________________________

City: _____________________________ State: _______ ZIP:______________

Product Manufactured: ___________________________________________________________

Number of Employees: __________ Number of Shifts: __________

To send this form to IAM District 27 please mail  to:

IAM District 27
824 S. Second St.
Louisville, KY 02032

502-587-0127

You may print this form and fax it to:
FAX (502) 587-9348