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LCEA Report Issues Form
This form is for LCEA members to report information to LCEA Leadership
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* Indicates required question
Current Status
*
Member
Retired
Not a member but would like to be
First Name
*
Your answer
Last Name
*
Your answer
School/worksite
*
Your answer
Non-Work Email
*
Your answer
Personal Phone number
Your answer
Questions, comments, or concerns etc.?
*
Your answer
Is this issue or concern happening to anyone else?
*
Yes
No
Maybe
Are you comfortable sharing this information with your building representative?
*
Yes
No
Maybe
Do you need assistance in contacting your building representative?
*
Yes
No
Maybe
Are you receiving the emails from LCEA currently (LCEA Connects & Newsletters)?
*
Yes
No
Maybe
Are you a member of the private LCEA Facebook group?
www.facebook.com/groups/lakecea/
Yes
No
Maybe
Clear selection
How are you getting information about LCEA (you may check more than one)?
Social Media/Website (Facebook/Twitter)
Email
Word of Mouth
Building Representatives
Other
Are you interested in being more involved in LCEA?
Yes
Maybe, I would like more information
I am already involved
No
Clear selection
Submit
Clear form
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