Members who reside in outlying districts more than 25 Miles from the designated balloting place: Members who are either confined because of verified illness; on vacation; on official IAM business approved by the Local Lodge, District Lodge or the Grand Lodge; on employer travel assignment; or on Military Leave as the case may be shall be furnished absentee ballots upon written request mailed or delivered to the Recording Secretary prior to the nominations meeting in accordance with the Grand Lodge rules for Local Lodge Elections and the Local Lodge bylaws.

REQUEST FOR ABSENTEE BALLOT

This form MUST be completed in its entirety.

I am requesting an absentee ballot for the upcoming election for the following reason (Check One)

_____ I reside more than 25 miles from the designated balloting place;

_____ I am confined because of a verified illness;

_____ I will be on vacation;

_____ I am or will be on official IAM business approved by the Local, District or Grand Lodge;

_____ I am or will be on employer travel assignment;    

_____ I am or will be on reserve Military Leave.

Name __________________________________________________________________

Address: ________________________________________________________________

                   (Street addresses only, no P.O. Box #s)

City:_______________________________ State:_______________ Zip:____________

Phone No: __________________________ Union Book No: ______________________

Employee No: ________________________ Airline:_____________________________

Signature:_________________________________________ Date: _________________