Steward Program Application

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP

Phone*

Email*

General Committee*

Local Division*

Are you an union officer?*

Yes
No

Please provide your title*

Are you currently enrolled in Cornerstone products?*

Yes
No

Have you ever filed a claim?*

Yes
No

Do you have any insurance experience?*

Yes
No

Explain your experience*

How many union meetings have you attended in the last 12 months?*

Please explain why you would like to be a steward*

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