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* 1. First Name

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* 2. Last Name

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* 3. State(s) you are actively working on Union Co-ops or Union Co-op Initiatives?

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* 4. Description of Union Co-op Activity. (i.e. Number interested? Number of union co-ops in progress? Number of co-ops launched?Number of workers and worker-owners? Successes to date? Challenges/hurdles/needs? )

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* 5. Email 

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* 6. Phone Number

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