AMFA Local 33 - January 2006 Election

Nomination Form for AMFA National vacancies

I, ______________________________, employee number ______________

nominate                                             ,  employee number                                      

for the position of:

� National Safety and Standards Director

� Region II Director

� Industrial Safety Coordinator

This nomination form must be delivered to the Local 33 office by hand, via US Mail, or via FAX (952-224-5436) and received by 4:00 PM, Friday February 17, 2006.          

Signature_____________________________

13-1247A

January 30, 2006

AMFA Local 33

8101 34^th Ave South - Suite 380

Bloomington, MN 55425