safety before profits Link to Community Shares of Greater Milwaukee

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So you want to join WisCOSH... GREAT CHOICE!!!!

Please fill in the form, submit it and the payment. Please note that this form IS NOT being sent over a secure connection and could be read by anyone with the knowlege on how to intercept the transmission. For privacy and security concerns please print and snail mail the application and fee to :
WisCOSH, Inc.
734 N. 26th St.
Milwaukee, WI 53233

WisCOSH does not sell, rent, give away nor share its databases nor its mailing lists and we respect the privacy rights of our members. By submiting this form on-line via e-mail your information may be viewed by persons who intercept this form of communication. E-mail should not be considered secure or encrypted unless you are using such an e-mail program that encrypts messages and encryption is active.

If you do not want your name and/or organization published in any informational/promotional products/literature, please indicate so when asked below. You may change your mind at any time by notifying WisCOSH in writing. WisCOSH may from time to time, when working in partnership with a person, group or organization, send out letters in conjunction with such arraingements to notify of or ask support for such partnership. In all situations WisCOSH maintains possession and control of the list(s) or batabase(s) used.

For maximum security, please print form, fill it out and mail to address above along with payment. For answers to any questions you may have call (414) 933-2338 in the Milwaukee area or 1-888-947-2674 toll free.

(all fields marked with * are required.)
Please give us your :

NAME:
First Name *: M.I.: Last Name *:

ADDRESS:
Street Address *: Apt.#: P.O.Box#: R.R#:

City *: , State *: Country : ZIP Code *:

E-Mail : Web Site:

CONTACT INFORMATION:

Phone Number's:

(home) : (work) :

(cell) : (fax) :

Please tell us about your Organization: (If applicable.)

What is the organization's name?

Where is it located? :

Street Address: Apt.#: P.O.Box#: R.R#:

City: , State: Country : ZIP Code :

Are you the normal contact person for the organization?
(PLEASE Check One!)
Yes, I am. No, I'm not.

May we use your name/organizations name, where appropriate, when publishing materials? *

What Type of Membership do You Want? *


* Union Membership - Annual Dues for Unions - ( minimum $75 - maximum $650 )
Members in Union/Local.

** Affiliate Membership - County, State, Regional, or National Associations of Unions may join as an affiliate member for $100 annually

Whether you submit the form online or print it and send to us please mail your dues to activate your membership and begin receiving the WisCOSH News Letter, Resource Directory, Occupational Safety and Health information.... Plus all your other great benifits

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