Registration Form



User Information

    First Name: 
     Last Name: 
         Title: 
  LIUNA Entity: 
Street Address: 
          City: 
         State: 
      Zip Code: 
     Telephone: 
           FAX: 
        E-mail: 
           URL: 

Rate the level of corruption  for the topic selcted

Select the mutually exclusive options that apply to topic selected:

Select the level 1 =low, 12= high:

Check 1    Check 2    Check 3    Check 4
Check 5    Check 6    Check 7    Check 8
Check 9    Check 10   Check 11   Check 12

Supply your LIUNA International membership number:

Membership Number

Date joined union

Form Submission

Information submitted will be held in confidence by Laborers for JUSTICE


james William McGough
Copyright © 1999 [Laborers for JUSTICE]. All rights reserved.
Revised: August 19, 1999.