When you and your coworkers sign authorization cards, you are expressing your desire to become a member of UFCW Local 371. It’s important to understand that when you sign an authorization card, you are not joining the UFCW. You are only expressing your desire to join the UFCW. You will not become a member of the UFCW until a) the company decides to recognize the union or b) a majority of the workers vote to join the UFCW in a secret ballot election.

Desiring to enjoy the rights and benefits of collective bargaining, I hereby authorize the United Food & Commercial Workers International Union, AFL-CIO-CLC, or its chartered Local Union(s) to represent me for the purpose of collective bargaining.

Print Name



Home Phone

Home Address

City, State, Zip

Employer’s Name

Employer’s Address

Your Hire Date

Type of Work Performed


Hourly Rate

E-mail address I work: List your days off:
( ) Day Shift
( ) Night Shift
( ) Part-time
( ) Full-time
Would you participate in an
organizing committee?
( ) Yes
( ) No

Mail this authorization form to UFCW Local 371 at:

UFCW Local 371
290 Post Road West
Westport, CT 06881-0470