Political Action Questionnaire

Name *

Employee ID # *

Unit #

Home Email *

Home Telephone *

Home Address *

Address 1 *

Address 2

City *

Province *

Postal code *

Work Telephone

Provincial Riding *

Federal Riding

General

	Yes	No
I am the Political Action Coordinator for my Unit	I am the Political Action Coordinator for my Unit - Yes	I am the Political Action Coordinator for my Unit - No
Are you willing to assist in a federation of labour political action campaign?	Are you willing to assist in a federation of labour political action campaign? - Yes	Are you willing to assist in a federation of labour political action campaign? - No
Are you willing to assist in the next provincial election campaign?	Are you willing to assist in the next provincial election campaign? - Yes	Are you willing to assist in the next provincial election campaign? - No
Are you willing to assist in the next Federal election campaign?	Are you willing to assist in the next Federal election campaign? - Yes	Are you willing to assist in the next Federal election campaign? - No
Are you interested in taking Political action training?	Are you interested in taking Political action training? - Yes	Are you interested in taking Political action training? - No
May we give your contact information to organizers coordination efforts for the Canada Labour Congress or your Provincial Fedeeration of Labour?	May we give your contact information to organizers coordination efforts for the Canada Labour Congress or your Provincial Fedeeration of Labour? - Yes	May we give your contact information to organizers coordination efforts for the Canada Labour Congress or your Provincial Fedeeration of Labour? - No

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