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Form NMB - 1 OMB No. 3140-0001 Expiration Date 7/31/2016 Application for Investigation of Representation Dispute Date TO THE NATIONAL MEDIATION BOARD Washington D. C. 20005 A dispute has arisen among the employees of Name of Carrier Address Contact City State Zip Code Telephone Number Fax Number as to who is the representative of these employees designated and authorized in accordance with the requirements of the Railway Labor Act. The undersigned one of the parties to the dispute hereby requests the National Mediation Board to investigate this dispute and to certify the name or names of the individuals or organizations authorized to represent the employees involved in accordance with Section 2 Ninth of the Act. PARTIES TO DISPUTE Petitioning organization or representative Organization holding existing agreement if any Date Other organization or representatives involved in dispute CRAFT OR CLASS of Employees Involved If more than one craft or class list separately Craft or Class Number of Employees EVIDENCE OF REPRESENTATION this application is supported by At least 50 Name and Signature Title Telephone Fax Instructions Continue to page 2. Page 1 of 2 APPLICANT NOTICE OF APPEARANCE The hereby enters the following names addresses Applicant Organization phone numbers fax numbers and email addresses for the individual s designated as the representative s of in connection with the Application for Investigation of Representation Dispute Name Title Email Alternate Telephone 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 3140-0001. 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* Page 2. C. 20005 A dispute has arisen among the employees of Name of Carrier Address Contact City State Zip Code Telephone Number Fax Number as to who is the representative of these employees designated and authorized in accordance with the requirements of the Railway Labor Act. The undersigned one of the parties to the dispute hereby requests the National Mediation Board to investigate this dispute and to certify the name or names of the individuals or organizations authorized to represent the employees involved in accordance with Section 2 Ninth of the Act. The undersigned one of the parties to the dispute hereby requests the National Mediation Board to investigate this dispute and to certify the name or names of the individuals or organizations authorized to represent the employees involved in accordance with Section 2 Ninth of the Act. PARTIES TO DISPUTE Petitioning organization or representative Organization holding existing agreement if any Date Other organization or representatives involved in dispute CRAFT OR CLASS of Employees Involved If more than one craft or class list separately Craft or Class Number of Employees EVIDENCE OF REPRESENTATION this application is supported by At least 50 Name and Signature Title Telephone Fax Instructions Continue to page 2. .