IBEW Local 43

Authorization for Representation

Please fill out the Authorization Card below. Print it, sign it and get it back to us right away. This is the first step toward better working conditions, better wages and a better future!

NOTE: Click "email-the-pdf" to have the card sent to the email address you listed in the form below, print it, sign it and get it back to us right awsy.

Authorization for Representation

I authorize a local union of the IBEW to represent me in collective bargaining with my employer.

First Name:

Middle Name:

Last Name:

Home Address:

City:

State:

Zip:

Home Phone:

Email:

Employer:

Location:

Department:

Manager:

Job Title:

Shift:

1ST

2ND

3RD

Date of Authorization:

Signature:

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