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Michigan Teamsters

Joint Council #43

2741 Trumbull Street

Detroit, MI  48216-9910

THE INTERNATIONAL BROTHERHOOD OF TEAMSTERS, CHAUFFEURS, WAREHOUSEMEN AND HELPERS OF AMERICA 

Date _______________________

 Phone (313) 965-7450

REPRESENTATION AUTHORIZATION AND APPLICATION FOR MEMBERSHIP

Name __________________________________________________________                 Married or Single

Address ________________________________________________________                               Date of Birth _____________________

City ________________________  State ________  Zip No. ___________                       Phone   (           ) __________________

Where Employed ________________________________________________                             Date Employed __________________

 Have you ever belonged to any Teamster Local Union?       Yes       No

If yes what local? ________________    

I hereby designate the International Brotherhood of Teamsters, Chauffeurs, Warehousemen and Helpers of America, through its authorized agents, as my representative for collective bargaining.

Michigan Teamsters Joint Council #43

Signed ______________________________________________________