Western Massachusetts Area Labor Federation Affiliation & Delegation Form

Form
Western Massachusetts Area Labor Federation

640 Page Blvd. Springfield, MA 01104Phone: 413-732-7970 Email: treasurer@wmalf.org
APPLICATION FOR AFFILIATION

If you are updating your delegation, please still fill out the entire form. This helps us ensure that our contact information for your local is up-to-date.
Thank you for affirming your commitment to building the labor movement and solidarity with other Local Unions in our area by affiliating with the Western Massachusetts Area Labor Federation. Your support and active involvement in the ALF will help us build a stronger and more effective Labor Movement for our members and their families. Please complete the information below and send this application with a check for your first month’s per capita payment to:

Western Massachusetts Area Labor Federation
640 Page Blvd, Room 101
Springfield, Massachusetts 01104
Union Information
International Union
Local #
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Principal Officers/Representatives
Principal Officer

First NameLast Name
Title
Email
example@example.com
Phone Number
Please enter a valid phone number.
Financial Officer

First NameLast Name
Title
Email
example@example.com
Phone Number
Please enter a valid phone number.
Mobilization Coordinator

First NameLast Name
Title
Email
example@example.com
Phone Number
Please enter a valid phone number.
Per Capita Calculation
Number of Members
Total Per Capita Payment (# of Members x $0.30)
Signature of Principal Officer

Powered by Jotform SignClear
Date

MonthDayYear
Date

Designation of Delegates

50 members or less 1 delegate	201-400 members 4 delegates
51-100 members 2 delegates	401-700 members 5 delegates
101-200 members 3 delegates	701-1100 members 6 delegates

1101 *One additional delegate for each additional 500 members or major fraction thereof above 1100.

Delegate Information

Delegate #1
Delegate #1 Name

First NameLast Name
Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.

Delegate #2
Delegate #2 Name

First NameLast Name
Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.

Delegate #3
Delegate #3 Name

First NameLast Name
Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.

Delegate #4
Delegate #4 Name

First NameLast Name
Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.

Delegate #5
Delegate #5 Name

First NameLast Name
Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.

Delegate #6
Delegate #6 Name

First NameLast Name
Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.

Delegate #7
Delegate #7 Name

First NameLast Name
Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.

Delegate #8
Delegate #8 Name

First NameLast Name
Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.

Delegate #9
Delegate #9 Name

First NameLast Name
Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.

Delegate #10
Delegate #10 Name

First NameLast Name
Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.

Signature of Principal Officer
Title of Principal Officer
Name of Principal Officer

First NameLast Name
I certify that the above named Delegate nominees are active, full dues-paying members in good standing with our Local Union, and that I expect them to remain so. I will notify the Area Labor Federation if this status changes, and designate a replacement Delegate.

Powered by Jotform SignClear
Date

MonthDayYear
Date
Should be Empty:

Form

Western Massachusetts Area Labor Federation

APPLICATION FOR AFFILIATION

Union Information

Principal Officers/Representatives

Per Capita Calculation

Designation of Delegates

Delegate Information