Veterans Contact Information Sheet
100%
Questions marked with a
*
are required
Exit Survey
Contact Information
First Name
:
Last Name (include Sr.,Jr, III)
:
Address Line 1
:
Address Line 2
:
City
:
State
:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Zipcode
:
Phone
:
Home Email Address
:
Identify Your Union Title (Member or Local Lodge Officer, District Council Delegate, District Council Alternate, Business Rep, Staff etc.)
Gender
Years Served in the Military
In which branch and/or branches have you served? Check all that apply
Air Force
Army
Coast Guard
Marine Corps
Navy
National Guard
Reserve
Other
Current IAMAW Status ( Active or Retired)
BEMSID Number or if non-Boeing, the last four of your SSN#
Willing to serve on a veteran service committee?
YES
NO
What Local Lodge are you?
(I.e. [Machinists, Toolmakers, Facilities Maintenance are in
Local C
]
[Assembly mechanics, forklift, crane operators, factory service are in
Local A
]
[QA, Expedite, tool room clerks are in
Local F
]
[Avionic technicians are in
Local E
]
Local A
Local C
Local E
Local F
Eastern WA Local 1951
Eastern WA Local 1123
Eastern WA Local 86
Other
*
Tee Shirt Size?
-- Select --
Small
Medium
Large
XLarge
2XL
3XL
4XL
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