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1. Please provide your first and last name (Required.)

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3. Please provide your cell phone number

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4. Which committee would you be interested in participating in for Local 2778? Select all that apply

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5. What does your availability look like for scheduled meetings and/or committee work? Select all that apply.

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6. What time between 9:00 AM - 7:00 PM on the above specified days will work best for you? Select all that apply.

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