Authorization for Representation

Authorization Card
 

Date:
First name:
Last Name:
Email Address:
Phone:
Home Address:
City:
State:
Zip code:
Name of Employer:
Work Location:
Department:
Job Title:
	By checking this box I understand and acknowledge that I am authorizing the International Brotherhood of Electrical Workers Local 108 to represent me as my bargaining representative in collective bargaining with my employer.  This Authorization is nonexpiring binding and valid until such time as I submit a written revocation.