IMPACT Registration


IMPACT Substance Abuse Program
Local Union Registration Form

The following information will begin the enrollment process for the IMPACT Substance Abuse Program. Upon submittal, a program representative will contact you.

Labor Contact
 
Local Union Name: 
 
Region: 
 
Members: 
 
Contact Name:(First / Last) 
 
Phone Number: 
 
Address: 
 
City: 
 
State: 
 
Zip Code: 

Management Contact
 
Contractor Association: 
 
Number Members: 
 
Contact Name:(First / Last) 
 
Phone Number: 
 
Address: 
 
City: 
 
State: 
  
 
Zip Code: 
  What is the best time to contact you?     
  Does your local union currently have provisions for a drug testing program in their Collective Bargaining Agreement? 
 
   
 
   
       

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