2025 JATSC Registration Form - IAM District 141

Step 1 of 2

This form must be completed and submitted by an Officer of the Local.

Submitter Name *

First

Last

Submitter Email *

Submitter Title *

Submitter Local *

Submitter Phone *

Name *

First

Middle

Last

Participant Suffix (Dr. Jr. Sr. Etc)

Participant Preferred Name or Nickname

Title States Participant

Participant Date of Birth *

Participant Gender

Participant Union Title

Participant Email *

Participant Phone *

Participant Local *

Participant District

Canada Participant Mailing Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country