Collaborative Leadership: Building Jobsite Leaders UBC Journeymen: Building Leadership for a Strong Future Carpenters International Training Center, Las Vegas, NVName* First Last UBC #*Which date would you prefer to go?*Preferred DateDecember 11-13 (2017)February 5-7March 5-7May 11-13July 9-11September 10-12Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* Phone*Email* Employer*Local Union*T-Shirt Size*SmallMediumLargeXLXXL3XL4XLPlease select one. **If no option is selected, size XL will be ordered.***What Airport would you prefer to fly from?*AirportLaguardia (LGA)John F Kennedy International (JFK)Newark Liberty (EWR)Job TitleJob TitleOwnerGeneral ForemanProject ManagerSuperEstimatorOtherSpecial RequirementsFor example: special diet, handicap accessible room, language assistance (translation services, hearing enhancement, etc.)Signature**IMPORTANT INFORMATION* If Applicable you must be a member in Good Standing – ***All Local Union Dues and Working Dues Assessments (WDA’s) must be paid up to date at the time of your application review. Member status will be verified on or before May 5, 2017. If you owe Local Union Dues or WDA’s, you will not be eligible to participate in the program. *All fields marked must be filled out completely in order to submit.