MLO 112fields

							                          APPLICATION FOR LOCAL CHARTER
                                   FORM MLO-112


This is an Application for Charter for a new CWA Local which will encompass the
following jurisdiction:

(Type complete Jurisdictional language here. Note: Line will extend as you type)




Reason for Charter application:


To be completed by                                 Signed: (five signatures required)
Vice President’s Office:
Date Approved:______________________               ____________________________

By:________________________________                ____________________________

I recommend the following number                   ____________________________
be assigned
Local:_____________                                ____________________________

Effective date of Charter:______________           ____________________________

Copy for                                           Date signed:__________________
International (original w/signatures)
District (copy)
Sector (copy)
Local (copy)

MLO-112
(04/03)