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Mail to Mediation Department National Mediation board 1301 k Street NW Suite 250 E. Washington DC 20005 Form NMB-2 OMB No. 3140-0002 Expiration Date 08/31/2016 Or fax to Mediation 202-692-5084 email mediation nmb. gov Application for Mediation Services TO THE NATIONAL MEDIATION BOARD Washington D. C. 20005 A dispute has arisen between the parties shown below which has not been adjusted between them and the services of the National Mediation Board under Section 5 First of the Railway Labor Act are hereby invoked on specific questions set forth below. The approximate number of employees involved is in the craft s or class es of. THE SPECIFIC ISSUE S IN DISPUTE If necessary extend question on additional sheet or attach exhibit PARTIES TO DISPUTE Carrier Organization/Individual Carrier Name Organization Name L* R* Official/Title Organization Official/Title Address City State and Zip Code Telephone Fax Email WORKING AGREEMENT If an agreement governing rates of pay rules or working conditions is in effect give name of parties thereto and date thereof* If there is no such agreement so state. COMPLIANCE WITH RAILWAY LABOR ACT 1. If this dispute involves change in the above-mentioned agreement attach copy of the 30-day notice served by party desiring change and insert date of notice here. of request here. 3. If there has been refusal to confer so state and give reason otherwise give date of last conference here Signed at this of City and State Day Carrier Official Month 20. Name Title Signature Filing Instructions File this application in duplicate. Additional Sheets Use and attach additional sheets as needed* According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is 3140-0002. The time required to complete this information collection is estimated to average 15 minutes per response including the time to review instructions search existing data resources gather the data needed and complete and review the information collection* Updated October 27 2008. gov Application for Mediation Services TO THE NATIONAL MEDIATION BOARD Washington D. C. 20005 A dispute has arisen between the parties shown below which has not been adjusted between them and the services of the National Mediation Board under Section 5 First of the Railway Labor Act are hereby invoked on specific questions set forth below. The approximate number of employees involved is in the craft s or class es of. THE SPECIFIC ISSUE S IN DISPUTE If necessary extend question on additional sheet or attach exhibit PARTIES TO DISPUTE Carrier Organization/Individual Carrier Name Organization Name L* R* Official/Title Organization Official/Title Address City State and Zip Code Telephone Fax Email WORKING AGREEMENT If an agreement governing rates of pay rules or working conditions is in effect give name of parties thereto and date thereof* If there is no such agreement so state.

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