Alameda Health System Bargaining Team Nomination Form

Use this form to nominate yourself or someone else to serve on our Bargaining Team. All nominations must be made by October 21, 2019.

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* 1. Please enter your contact information below. This will be used only to verify your membership: all your answers will be kept confidential.

Name

Personal Email Address

Personal (Cell) Phone Number

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* 2. What is your classification?

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* 3. What is your department?

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* 4. What campus do you work at?

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* 5. I am an SEIU 1021 member.

Yes

No

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* 6. I am nominating myself. (Select "No" to nominate someone other than yourself.)

Yes

No