By filling out and submitting this form, I authorize Local Union 613 of the International
Brotherhood of Electrical Workers to represent me, as my National Labor Relations Act (NLRA)
Section 9(a) bargaining representative, in collective bargaining with present and future
employers on all present and future jobsites within the jurisdiction of the Union. This
Authorization is non-expiring, binding and valid until such time as I submit written
revocation.