Name                Date

Address         Zip code

Home Phone      Work Phone

Cell Phone                    Pager

Work Location (check appropriate)

211 W. Monroe 
1301 W. University
1355 W. University-        CSSC          BPC
1231 W. University-        4E                NAMACC
7300 E. Hampton-           CRM           RAM          LNS

Regular Committees

Community Services                     Education/Mobilization
 (1^st Thursday Monthly @ 5:30pm)                         (2^nd Wednesday Monthly @ 10am & 5:30pm)

Election                                        Equity
(As Need-Committee approval required)                  (3^rd Tuesday Monthly-time varies)

                   
Legislative/Political                        Organizing
(1^st   Wednesday Monthly @ 5:30pm)                              

                                             
Newsletter
(As Needed)

If you are selecting more than one committee please list your first three choices:

1)

2)

3)

All meetings will be held at the hall unless otherwise noted.

opeiu 56, afl-cio
 revised 06/20/01

Please submit this application.  It will be mailed to the hall and you will be contacted.