GMB Member Mapping - Secure Form

First name*

Last name*

Email*

Phone*

Birthday*

Day

Month

Year

Address*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Company name*

Position*

What platform you work on ?*

Days or Nights *

Day Shift

Night Shift

Signature - I agree for GMB to store this information and contact me about union matters.*

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