Office held of (home address)........................................ ..................................................................... Signed ......................................................... Date.............................................................. Name ...........................................................
Office held. No member shall be recognized by the Employer as an OPBA representative until the OPBA has presented the Employer with written notification of that person's selection.
Office held. Club 1..................................................................................................... Signature .............................................................................................
Office held. Name of authorised person (print)
Office held. No employee shall be recognized by the Employer as an Union representative until the Union has presented the Employer with written certification of that person’s selection.
Office held. Name of authorised person (block letters) ............................................................ Signature of authorised person ............................................................ Office held ............................................................ Name of authorised person (block letters)
Office held. Name (print) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Office held. AL1164-IV | OCT 2019
Office held. Where the Member is an individual or partnership:
Office held of (home address)........................................