GMB Member Mapping - Secure Form

First name

Last name

Phone

Birthday

Day

Month

Year

Address

Multi-line address

देश/क्षेत्र

पता

शहर

ज़िप/डाक कोड

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.

हस्ताक्षर फ़ील्ड खाली है.

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