2017 Division Meeting Registration

Welcome to the registration page for the 2017 IUE-CWA Division Meeting. If you have questions contact Terri Hungate at 937-298-9984.

1. Name of person filling out this form. *This question is required.

2. IUE-CWA Local number *This question is required.

3. Title of person filling out this form. *This question is required.

4. Phone number of person filling out this form. *This question is required.

5. Email of person filling out this form. *This question is required.

6. Total number of people you are registering to attend the IUE-CWA Division Meeting *This question is required.

7. Division Meeting Registrant Information

Please enter information for each person from your local attending the Meeting. *This question is required.

First Name *This question is required.

Last Name *This question is required.

Title at Local *This question is required.

Email *This question is required.

Cell phone *This question is required.

Is this registrant attending as a Delegate, Alternate Delegate, or Guest? *This question is required.

If Delegate or Alternate, write date of secret ballot election, If guest, write N/A. If the person is attending as an automatic delegate based on their position as a local officer according to local bylaws, write the date of their election as president of the local. *This question is required.

Will this person be attending the CWA Convention? *This question is required.

Yes
No

8. Reception at Pittsburgh Pirates baseball game - Monday, Aug 7 at 7pm
$10 per person. Space is limited so each local is restricted to 4 tickets - more tickets may become available. Food and drink will be included. You must send a check payable to IUE-CWA for the total amount of those registered for the reception. Include the names of those attending the reception with the check and send to IUE-CWA, Attn: Registration, 2701 Dryden Road - Dayton, OH 45439.

Please list the names of the people you are registering for the reception (up to 4). *This question is required.

Name 1
Name 2
Name 3
Name 4
If you would like to be put on the waiting list for extra tickets, put the number of tickets you want here:
If not registering anyone for the reception, write "none" here: