IBEW AUTHORIZATION FOR REPRESENTATION

IBEW AUTHORIZATION FOR REPRESENTATION
I authorize the International Brotherhood of Electrical Workers to represent me as my bargaining representative in collective bargaining with my employer.
Date *

Month Day Year
Date
Name *

First Name Last Name
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Employer *
Location *
Department *
Job Title *
By checking the box below I understand and acknowledge that I am authorizing the International Brotherhood of Electrical Workers to represent me as my bargaining representative in collective bargaining with my employer. This Authorization is non-expiring binding and valid until such time as I submit a written revocation. *

I Agree
Should be Empty: