Intent Card Form

Undersigned *

I, the undersigned, authorize Fairfax Workers Coalition (FWC) to represent me as my exclusive bargaining agent with my employer, Fairfax County Government.

NAME: *

First

Last

PHONE: *

ADDRESS:

Address Line 1

City

State

Zip Code

EMAIL: *

JOB TITLE (optional):

AGENCY (optional):

Layout

SIGNATURE: *

DATE: *

Part of the FWC

Yes, I would like to be part of the FWC organizing committee.

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