Table Officers Training - Fall 2025 | Hospital Employees' Union

First Name

Last Name

Preferred Phone Number

Type of preferred phone number:

Secondary Phone Number

Type of secondary phone number:

Personal Email

(Do not use the employer email)

Job Title

Employer

Work Site Name

HEU Local (if known)

Local meeting election date

What HEU Local Executive position do you hold?

Emergency contact name

Emergency contact phone

If yes, please briefly explain. (In some cases, a physician's note may be required).

If so, please specify: