Steelworker's Personal Information

Last Name First Middle

Nicknames (if any)

Current Address

City State Zip

Phone Number e-mail

Date of Birth (mm/dd/yyyy)

Place of Birth (city, state or city, country, if not U.S.)

Employment History

Union Affiliation & Local Union Position if any

Steel Company Plant

Year Began Ended

Family History

Fathers Name Mothers Maiden Name

Additional Family Members Employed at Steel

Your Story

Describe briefly your family's background, cultural history, etc. as it relates to working at the Steel.

Donated Material

Authorization to archive donated materials and interviews (audio, video, photographic)

I, the above named person, grant the Steelworkers' Archives, Inc., Bethlehem, Pennsylvania. permission to archive all donated materials (flat artifacts, and three dimensional) and interviews (audio, video, photographic), and use all the generated materials according to the needs of the Steelworkers' Archives Inc.

Digital Signature

by checking this box, you acknowledge you have read and agreed to the above statement.