NWRegionLaborersRisingActivitySurvey

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Email *

Name (First and Last) *

Local Union (Select by Number) *

Member ID # (Please do not put down your Social Security Number. If you don't have a Member ID, put N/A) *

Mobile Phone

(By providing your email and phone, you confirm your consent to receive messages from LIUNA & its affiliates, including any autodialed call, text message or email, about important matters, including your contract, benefits, union operations, political, and legislative matters. You can opt-out at any time.)

Phone Number *

What are you checking in for? *

Local Union Meeting

Charity Effort

POWER/VOICE/RISE Training

Holiday Event

Volunteer Organizing Comm. Meeting

Neighborhood Clean Up

Retiree Event

Other - Explain below

Required

If you selected Other, list the activity below. If you didn't select other, skip this question.

How did you hear about this activity? *

If selected Other, list the activity below. If you didn't select other, skip this question.

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