Building/Sticker Captains

Please fill out this form to sign up to be a building/sticker captain. As a captain, you will get stickers and union t-shirts to coworkers and inform coworkers of upcoming events. Your union is only as strong as your participation!

If you have any questions, please contact Bennett Nagurka, Staff Representative, HPAE, at 703-472-8033 or email bnagurka@hpae.org

Question Title

1. Name (Required.)

Question Title

2. Which department do you work under? (Required.)

UCHC (Corrections)

RWJMS

UBHC

NJMS

Other (please specify)

Question Title

3. What is your job title? (Required.)

Staff Nurse

APN

CRNA

Nurse Clinician

Research Nurse Clinician

Other

Question Title

4. What is the best number to reach you? (Required.)

Question Title

5. What is the best time to call you generally? (Required.)

Question Title

6. What is the best email to reach you? (Required.)

Thanks! An organizer will reach out to you!

Building/Sticker Captains

Question Title

* 1. Name (Required.)

Question Title

* 2. Which department do you work under? (Required.)

Question Title

* 3. What is your job title? (Required.)

Question Title

* 4. What is the best number to reach you? (Required.)

Question Title

* 5. What is the best time to call you generally? (Required.)

Question Title

* 6. What is the best email to reach you? (Required.)

1. Name (Required.)

2. Which department do you work under? (Required.)

3. What is your job title? (Required.)

4. What is the best number to reach you? (Required.)

5. What is the best time to call you generally? (Required.)

6. What is the best email to reach you? (Required.)