Delegate Update Form

Delegation Update 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.
Union Information
International Union
Local #
Per Capita Calculation
Number of Members
Total Per Capita Payment (# of Members x $0.30)
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.

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