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 THIS FORM USING THE BUTTON BELOW AND FILL IN:
  To send this form by postal mail or to contact IAM District 90 by mail please write to:

Main Office
5638 Professional Circle  Suite 201
Indianapolis, IN   46241-5022

Or Telephone
Phone: 317-247-8488

You may print this form and fax it to:
FAX 317-247-8825