(This form revised 12-04-2022 (C0013) By submitting this confidential completed Union Authorization for Representation Form, (Amazon will never see this information only the U.S. Government) you show your support to start Union Amazon Organization-a group of your coworkers and yourself at Amazon. Section 7 of the National Labor Relations Act of 1935 is a foundational statute of United States labor law and guarantees employees “the right to self-organization, to form, join, or assist labor organizations, to bargain collectively through representatives of their own choosing, and to engage in other concerted activities for the purpose of collective bargaining or other mutual aid or protection . . .”. You designate Union Amazon Organization (once formed) as your exclusive bargaining agent to represent you for the purpose of collective bargaining with Amazon. Once formed, Union Amazon Organization dues will be 1% of your gross weekly pay period income. You reside in a “Right to Work State” and you are not required to join a union or pay union dues as a condition of employment. Once formed, if you do not join Union Amazon Organization, you pay no union dues and Union Amazon Organization will legally represent you in any matter- such as during a grievance procedure, an employee disciplinary action, etc., you will be included in and covered by any Union Amazon Organization labor contract with Amazon, but you will not be entitled to any Union Amazon Organization services or benefits beyond those matters in respect to your interaction with Amazon. Please join and help support our union by paying dues and mostly by participating in providing the services and benefits offered.