First name
Last name
Email
Mobile
1.
If a Chapter does not yet exist for your title, are you willing to help form one?
Please select
Yes
No
2.
What are the main issues you would like to address with other union members in your title?
3.
Once a Chapter is formed, are you interested in serving as a Chairperson or Secretary to help guide it?
Please select
Chairperson
Vice-Chairperson
Secretary
Interested, but not sure which role
None
4.
Can we put you in touch with other union members in your title who are also interested in forming a chapter?
Please select
Yes
No