LOCALS 175 & 633 YOUTH LEADERSHIP DEVELOPMENT PROGRAM APPLICATION FORM
Applicant Information
First Name:
Last Name:
E-mail:
Permanent Home Address:
City:
Province:	Select... Ontario Northwest Territories Nunavut Quebec Newfoundland Prince Edward Island Nova Scotia New Brunswick Manitoba Saskatchewan Alberta British Columbia Yukon
Postal Code:
Telephone:	()   -
Workplace
Years as a member
Are you under 30 years of age?
Yes No
Are you a member of your workplace Joint Health & Safety Committee?
Yes No
What other Union exposure/activities have you been involved in, if any? (Labour Council, Labour Day Parade, Leukemia Events, etc.).
In point form, please answer: How do you feel you would benefit from taking this program?