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Electronic Authorization Form

Electronic Authorization Form

This Authorization form is the first step in the process for representation but not union membership. The only way you become a union member is after winning a representation election, negotiating an employee-approved Collective Bargaining Agreement, and signing a dues checkoff form.

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Member Information

Please select:

Your First Name

Your Last Name

Date of Birth

Last Four of Social Security Number

(This information is required in order to sign you up as a UMWA Member, it will not be shared with any entity outside of the union.)

Your Phone Number

Your Email

Your Mailing Address

Your Mailing City

Your Mailing State

Your Mailing Zip Code

Your Employer

Date of Hire

Your Signature

Today's Date

By electronically signing this form, you authorize the United Mine Workers of America to represent you as an exclusive collective bargaining agent in all matters pertaining to wages, hours, terms, and conditions of employment. This authorization cancels any similar authority previously given to any other person or organization.