TEAMSTERS HISPANIC CAUCUS

                                                                                                         DATE/FECHA____________

                                                                                                         PAID____________________

FAVOR DE COMPLETAR ESTA FORMA

Name/Nombre_______________________________________________________________

Home Address/Direccion de Casa ________________________________________________

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Home Phone/Tel.De Casa________________    Local Union#________________

e-mail_______________________________     Members#__________________

Membership Fee: $20.00 Per Year

Teamsters Hispanic Caucus, P.O. Box 12994, Chgo,IL. 60612 * chgo-thc@excite.com