DISTRICT 8  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 8 please mail or fax to:

Main Office
I.A.M.A.W. District 8
16W 361 South Frontage Road,Suite #127
Burr Ridge, Illinois 60527

Our Telephone
Chicago Number: (773) 287-4130
Suburban Number: (630) 321-3880

You may print this form and fax it to:
FAX (630) 321-3886

4/09/2009