Select your registration type: Please select Delegate (With Companion) Delegate (No Companion) Guest Speaker (With Companion) Guest Speaker (No Companion)
Member Information
IBEW Card Number
First Name
Last Name
Name (As you would like it to appear on your conference badge)
Select your T-shirt size Please select Small Medium Large X-Large XX-Large XXX-Large XXXX-Large
IBEW Local #
IVP District # Please select District 1 District 2 District 3 District 4 District 5 District 6 District 7 District 8 District 9 District 10 District 11 I don't know my IVP district N/A
Membership Status Please select Active Retired Guest
Occupational Branch Please select Inside Construction Outside Construction Professional & Industrial (P&I)
Local Union Position Please select Business Manager President Vice President Recording Secretary Treasurer Executive Board Member JATC Instructor Training Director or JATC Staff Organizer Business Representative Apprentice Coordinator Rank and File Member Local Union Office Staff Other N/A
EWMC Membership Information
EWMC Chapter Please select L.U.1 Greater St. Louis L.U. 3 New York L.U. 6 San Francisco, CA. L.U. 11 Los Angeles, CA. L.U. 15 Downers Grove, IL. L.U. 18 Los Angeles, CA. L.U. 24 Baltimore, MD. L.U. 25 Long Island, NY. L.U. 26 Washington DC L.U. 46 Seattle, WA. (Fredrick Simmons) L.U. 47 So. California L.U. 48 Portland, OR. (Gus Miller) L.U. 58 S.E. Michigan L.U. 68 Denver, CO. L.U. 89 No. Cascades Chapter L.U. 98 Philadelphia, PA. L.U. 103 Boston, MA. L.U.110 St. Paul, MN. L.U. 112 Kennewick, WA (Aaron Siefken) L.U. 113 Colorado Springs, CO. L.U. 124 Greater Kansas City L.U. 130 New Orleans, LA. L.U. 134 Chicago, IL. L.U. 159 Madison, WI. L.U.177 Jacksonville, FL. L.U. 197 Bloomington, IL. L.U. 213 Vancouver, CA. L.U. 252 Ann Arbor, MI. L.U. 275 Coopersville, MI. L.U. 292 Minneapolis, MN. L.U. 332 San Jose, CA. L.U. 340 Sacramento, CA L.U. 353 Toronto, Canada L.U. 357 Las Vegas, NV. L.U. 429 Nashville, TN L.U. 479 Beaumont, TX. L.U. 481 Indianapolis, IN. L.U. 520 Austin, TX. L.U. 558 Sheffield, AL. L.U. 569 San Diego, CA. L.U. 595 Oakland, CA. L.U. 613 Atlanta, GA. L.U. 617 San Mateo, CA. L.U. 640 Phoenix, AZ. L.U 668 Lafayette, IN. L.U. 697 Gary/Hammond, IN. L.U. 716 Houston, TX. L.U. 824 Tampa, FL. L.U. 1049 New York L.U. 1245 Vacaville, CA. L.U. 1579 Augusta, GA. L.U. 2150 Milwaukee, WI. Roland Carter Fourth Dist.
Officer Position Held Within Chapter Please select President Vice President Recording Secretary Treasurer At-Large Executive Committee Member N/A
Additional Position Held Within Your Local Union (if applicable) Please select Business Manager President Vice President Apprentice Coordinator Rank and File Journeyperson Recording Secretary Treasurer Executive Board Member JATC Instructor Training Director of JATC Staff Organizer Business Representative
Gender Info
Gender
Preferred Pronoun(s)
Demographic Information
Ethnicity
Age Range Please select 18-35 36-50 51-62 63+
Contact Information
Phone Number (without dashes '-')
Email Address
Address
Position in International Office Please select President International Secretary/Treasurer International Vice President IEC Member International Rep Other N/A
Dietary Restrictions
Dietary Restrictions (cont'd)
Food Allergies
Food Allergies (cont'd)
EWMC 2027 Conference Waiver
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Emergency Contact Name
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