Public Sector Authorization for Representation Social share icons You must have JavaScript enabled to use this form. Leave this field blank First Name Last Name Home Address Apartment, Suite, etc. City State - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Personal Email Employer Department Work Site Address Job Title Work Hours Home Phone Cell Phone 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 Reset 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 Sign Your Card
