First Name:_________________________ Last Name:__________________________________
Address 1:_______________________________________________________________________
Address 2:_______________________________________________________________________
City: ______________________________________ State: ________Zip:_____________
Phone: ( ______ ) _______ - _________ FAX: ( ______ ) _______ - _________
E-mail___________________________________________________________
Employer:________________________________________________________
Work Address 1: _________________________________________________________________
Work Address 2: _________________________________________________________________
City: _____________________________ State: _______ ZIP:______________
Type of Work / Industry: __________________________________________________________
Number of Employees: __________ Number of Shifts: __________
To send this form by postal mail or fax to Mechanics Local 701:
Mechanics Local 701
500 West Plainfield Rd.
Countryside, IL 60525
To contact Local 701 call
(708) 482-1720
FAX
(708) 482-1750