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Get CA PERB 920 2012

E person whose name and address appears below, and authorize such representative to appear on my behalf in this preceding. This designation shall remain valid until I file a written revocation of it with the Public Employment Relations Board. (Signature) (Name of Representative) (Printed Name) (Title) (Title) (Organization) (Date) (Mailing Address) (City) (Zip) ( ) (Telephone Number) (Ext.) ( ) (Fax Number) (E-Mail Address) (BOARD AGENT: __________) PERB 920 (5/2012) .

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