First Name:

Last Name:


I am a Labor Summer Intern:
Yes     No

Title:


Union:
(N/A for Labor Summer Interns)
Local #:
(N/A for Labor Summer Interns)

Address:

City:
  State:   Zip:

Home Phone:

Mobile Phone:

Business Phone:

Fax:


Email:

Billing Information (if different from above, N/A for Labor Summer Interns)

First Name:

Last Name:


Address:

City:
  State:   Zip:

Phone:


Email:

Please tell us about your interest in this course.

What research duties do you have at your union? (N/A for Labor Summer Interns)

What skills do you hope to learn?