MTA Site Representative List Form

Click on the first text box and type the information requested. You may then use your tab key to jump from box to box. Please complete the following information and click on the "submit form" button (once) at the bottom of page.

Site:

Date Form Completed:

Person Completing Form:

Faculty Club Chairperson:

Home Phone:Site Extension:Email:

Safety Commitee Rep*:

Home Phone:Site Extension:Email:

Building Rep Chairperson:

Home Phone:Site Extension:Email:

1. Building Rep**:

Home Phone:Site Extension:Email:

2. Building Rep**:

Home Phone:Site Extension:Email:

3. Building Rep**:

Home Phone:Site Extension:Email:

4. Building Rep**:

Home Phone:Site Extension:Email:

5. Building Rep**:

Home Phone:Site Extension:Email:

6. Building Rep**:

Home Phone:Site Extension:Email:

7. Building Rep**:

Home Phone:Site Extension:Email:

8. Building Rep**:

Home Phone:Site Extension:Email:

9. Building Rep**:

Home Phone:Site Extension:Email:

10. Building Rep**:

Home Phone:Site Extension:Email:

11. Building Rep**:

Home Phone:Site Extension:Email:

12. Building Rep**:

Home Phone:Site Extension:Email:

13. Building Rep**:

Home Phone:Site Extension:Email:

14. Building Rep**:

Home Phone:Site Extension:Email:

1 . Building Rep Alternate***:

Home Phone:Site Extension:Email:

2. Building Rep Alternate***:

Home Phone:Site Extension:Email:

3. Building Rep Alternate***:

Home Phone:Site Extension:Email:

4. Building Rep Alternate***:

Home Phone:Site Extension:Email:

5. Building Rep Alternate***:

Home Phone:Site Extension:Email:

6. Building Rep Alternate***:

Home Phone:Site Extension:Email:

7. Building Rep Alternate***:

Home Phone:Site Extension:Email:

8. Building Rep Alternate***:

Home Phone:Site Extension:Email:

9. Building Rep Alternate***:

Home Phone:Site Extension:Email:

10. Building Rep Alternate***:

Home Phone:Site Extension:Email:

11. Building Rep Alternate***:

Home Phone:Site Extension:Email:

12. Building Rep Alternate***:

Home Phone:Site Extension:Email:

13. Building Rep Alternate***:

Home Phone:Site Extension:Email:

14. Building Rep Alternate***:

Home Phone:Site Extension:Email:

* Must be voted into office by members of the bargaining unit at the site.

** The site is entitled to 1 per 10 members at the site. Half should be elected in odd years and half in even. All terms are for two years.

*** The site is entitled to 1 alternate per Building Rep.

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