Authorization for Representation

First Name

Last Name

Home Address

Apartment, Suite, etc.

City

State

ZIP/Postal Code

Personal Email

Employer

Department

Work Site Address

Job Title

Work Hours

Home Phone

Cell Phone †

† By providing my cell phone number I consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME and its affiliated labor, political and charitable organizations on any subject matter. My carrier’s rates may apply. I may modify my preferences by calling the Union at 218-885-3242 or emailing the Union at info@afscme65.org.

Authorization for Representation

I understand and agree that by signing and dating this card, I authorize AFSCME Council 65 to secure recognition from my employer as my sole and exclusive collective bargaining representative for purposes of wages, hours and conditions of employment.

Signature

My electronic signature is a binding and valid signature. By signing here I agree to all of the terms and conditions set out in this authorization.

Date Signed