DISTRICT 9  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 9 please mail or fax to:

Main Office
IAMAW District 9
12365 St. Charles Rock Road
Bridgeton, MO 63044

Our Telephone
314-739-6200

You may print this form and fax it to:
FAX 314-739-1342

or E-Mail us at
district9@district9.org