EmailMe Form - United Federation LEOS-PBA

Name *

First Last

Phone *

### - ### - ####

Email *

Company you work for *

State of Location you work at? *

Number of Officers at your Location? *

Are you presently represented by a Union?

Yes

No

Not sure

If YES do you know the name of your present Union?

United Federation LEOS-PBA and its affiliated Unions Membership Authorization Form *

I hereby authorize the United Federation LEOS-PBA and its affiliated Unions to represent me, for the purposes of collective bargaining to improve wages, benefits & other conditions of employment. All information Strictly confidential.

Type Applicant Name *

I also wish to join the United Federation LEOS-PBA Organizing Committee please contact me.

YES

Applicants Signature *

Clear

Date Signed *

MM / DD / YYYY