By completing the form below and clicking “submit,” I am authorizing the UMWA to represent me for the purpose of collective bargaining with my employer. My right to submit this authorization is protected by Federal law. Your First and Last Name (required) Your Phone Number (required) Your Email (required) Your Address (required) Your City (required) Your State (required) AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Your Zip Code (required) Your Employer (required) Today's Date