Candidate Petition

Office of the Election Supervisor for the International Brotherhood of Teamsters

Candidate Accreditation Reporting System

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^*I am a member of the:

^*My IBT Local, GCC Local, BMWED Lodge or BLETD Division is:

Based on the information you provided above, you may sign this petition for the following candidates:

SLATE NAME:Teamster Power Slate

Important Notice to IBT Member: This is a petition to have each person on the slate listed above declared to be an "Accredited Candidate" for the IBT International Union Oﬃce listed next to their name. In order to qualify as an Accredited Candidate, a candidate must obtain signatures of at least two and one-half percent (2.5%) of all IBT members eligible to vote for the oﬃce being sought. You may sign petitions for any number of separate candidates for the same position, but you may only sign one petition for a particular candidate. By providing the information requested you consent to use of the information by the Oﬃce of the Election Supervisor for purposes of monitoring, investigating, and enforcing compliance with the Rules of the 2020-2021 IBT International Union Delegate and Oﬃcer Election (the "Election").

All required fields are notated with an asterisk (^*)

^*Your First Name:

^*Your Last Name:

To conﬁrm eligibility, enter EITHER last 4 digits of your SSN/SIN OR your complete mailing address.

Enter the last 4 digits of your SSN/SIN:

OR enter your complete mailing address including ZIP/Postal Code:

Address 1:

Address 2:

City:

State:

ZIP/Postal Code:

Country:

In order to ensure the security and integrity of the petition process, we need to verify that you personally have signed the petition.

We will send you an electronic message (email or text message) to verify that you personally completed this form. You MUST reply to this message in order to complete this process and have your signature count for these candidates. Please follow the instructions in the message you receive.

Please provide either your mobile phone number or email address below:

Mobile Phone Number:

Email Address:

^*I hereby certify that I am a member in good standing of the IBT and I am affixing my electronic signature to this petition. I further agree to have this signature validated via email or SMS text message as indicated above to verify this electronic signature.

I agree that my Name, Mailing Address, Email and Mobile Phone Number as provided above may be shared with the candidate or slate named above for campaign activity in connection with the 2020-2021 IBT International Union Delegate and Officer Election (the "Election"). If I do not affirmatively check this box I understand that my name and local number will be visible for the purpose of the Election, but no additional information will be shared.

^*Type Full Name:

Date: 7/5/2022

Once you have entered all required fields, please submit the form.