IBEW UNION AUTHORIZATION CARD

Date

First Name *

Last Name *

E-Mail *

Phone Number *

Street Address

City

State

Zip Code

Employer Name

Work Location

Department

Job Title

I Agree - By checking this box 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 nonexpiring binding and valid until such time as I submit a written revocation.