Request for Employee Representation Election Under the National Labor Relations Act

Transport Workers Union of America, AFL-CIO

I authorize the Transport Workers Union of America, AFL-CIO, to request the

National Labor Relations Board to conduct an investigation and a representation

Election, also to represent me in all negotiations of wages, hours and working conditions

in accordance with the NLRB. This does not obligate me financially in any way.

PLEASE PRINT CLEARLY

Name ____________________________________________________

Home Address _____________________________________________

City ___________ State ____ Zip Code _______ Phone ____________

Employed By ______________________________________________

How Long ___________________ Job Title _____________________

Date _____________ SIGN HERE _____________________________

Signature is required for card to count

E-mail ___________________________________________________

Shift: Graveyard ___ Dayshift ___ Swingshift ___

THIS CARD IS CONFIDENTIAL.

Your Employer Never Sees It. It Goes to the U.S. Government

After completing this card, please MAIL TO:

Transport Workers of America

2770 S. Maryland Parkway

Suite 510

Las Vegas, NV 89109

Phone: 702-476-0648