Authorization Card

I, the undersigned, hereby make APPLICATION FOR MEMBERSHIP in the UTILITY WORKERS UNION OF AMERICA (AFL-CIO). I hereby designate the Utility Workers Union of America to act as my sole and exclusive representative for the purpose of collective bargaining with respect to wages, hours and conditions of employment and I hereby withdraw all previous designations of any other organization as my collective bargaining agent.

Personal Information

Name(Required)

First Last

Email(Required)

Phone Number

Home Address

Street Address City State ZIP Code

Professional Information

Company Name

Worksite Address

(Skip if unknown)

Street Address Address Line 2 City State ZIP Code

Occupation

Department

Signature(Required)

Date(Required)

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.