SEIU Local 105 Steward Application (Part 2 of 2)

Name: Rochelle Moore_____________________________ E-mail: Rochelle.X1.Moore@kp.org_________________

Cell Phone:___________________________ Worksite/Building/Department:MSCC_____________________________

Number of SEIU Local 105 members in your Worksite/Building/Department:________________________

Please circulate and have either fifty (50) or a majority of your co-workers (whichever is less) sign this form as part of the application process.

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