Unifor Local 39-O Membership Update
Employee Number:
Net Credit Service:
Surname:
Given Name:
Home Address:
City:
Postal Code:
Home Phone:
Home Cell:
Company Contact Cell #:
Home E-mail Address:
(Not a Company E-mail Address)
Company Contact Pager #:
Work Address:
Manager:
Are You A Member?:
Do You Have A Membership Card?:
Any Comments?:
Case Senative
(YYYY-MM-DD)