Representation Request Form	FOR OFFICE USE ONLY Date joined Accord: Subs up-to-date? Case Passed To: Date: Initials: Please send fully completed form to info@accordhq.org or post to: Freepost ACCORD UNION You will be contacted within 48 hours after we’ve received your form. FOR MEMBER TO COMPLETE Name: Employer: If other, please confirm: Membership/Employee No: Contact No: Email: __________________________________________________________ Workplace Address: Workplace Postcode: __________________________________________________________ Type of Meeting: If other, please confirm: Meeting Date: Meeting Time: Meeting Venue: Hearing Manager: Contact No: Email Address: Are HR Involved? If so, please provide name: Contact No/Email: Please give a short summary of the situation: