Form Lm-20 - Agreement And Activities Report Form - U.s. Department Of Labor Page 2

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Filer:
File Number C-
9. Check the appropriate box to indicate whether an object of the activities undertaken, is directly or indirectly:
To persuade employees to exercise or not to exercise, or persuade employees as to the manner of exercising, the right to organize and bargain
a.
collectively through representatives of their own choosing.
To supply an employer with information concerning the activities of employees or a labor organization in connection with a labor dispute involving
b.
such employer, except information for use solely in conjunction with an administrative or arbitral proceeding or a criminal or civil judicial proceeding.
10. Terms and conditions (Explain in detail; see instructions. Written agreements must be attached.):
Add Additional Activity (Item 11)
Specific Activities to be Performed
11. For each activity, separately list in detail the information required (See instructions):
a. Nature of activity:
11.b. Period during which performed:
11.c. Extent performed:
11.d. Name and address through whom performed:
Additional Name and address through whom performed, if any:
Name
Name
Organization
Organization
P.O. Box, Bldg., Room No., if any
P.O. Box, Bldg., Room No., if any
Street
Street
City
City
State
ZIP Code + 4
State
ZIP Code + 4
Add More Names (Item 11.d.)
12.a. Identify subject groups of employees:
12.b. Identify subject labor organizations:
Form LM-20 (2003)
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