2024 Delegate Profile Form - IAM District 141

Name *

First

Last

Your Email *

Please give us your personal email address. For security reasons, we cannot accept company email accounts.

Phone *

Local Lodge *

Your Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Are you a first-time delegate? *

Are you a retiree? *

On Wednesday, October 30, we will be hosting a dinner cruise on the San Francisco Bay. Seating for this event is limited, so please let us know if we should expect your guest to join us on this dinner service. *

If you would like to register more than two guests to this ticketed event, please contact Ann Clifford at (650) 554-1024. We will do our best to accommodate additional guests.

Is this guest under 21?

Do you work for United Airlines? *

Do you need us to request time off for you to attend this event? *

Employee Number

Airport or Station Code

Please let us know where you work. Example: SFO, IAH, ORD, etc.

Please tell us what department you work in.

Managers Name

First Day Off Needed

Last Day Off Needed

Destination

(Pre-filled)

Event Name

(Pre-filled)

Committee Assignments

Select your preferred committee assignments. Please make three choices, ranked from your first choice to your third choice. If you do not request a committee, your assignment will based on availability and the needs of the District.

First Choice *

Second Choice *

Third Choice *

We will do our best to give you your first choice of committee assignment.

What LOCAL LODGE Roles do you currently hold? (Check all that apply.) *

By-Laws
Communications
Community Service
Employee Assistance Program
Education
Finances
Human Rights
MNPL / Legislative
Organizing
Retirees
Safety
Women's
None

Are you currently serving as a Local Lodge Officer? *

Please Choose

President
Vice President
Secretary-Treasurer
Recording Secretary
Conductor Sentinel
Trustee
Auditor

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2024 IAMAW District 141 Convention Delegate Profile Form

Committee Assignments