Exhibit H

Declined Union Representation


Teacher : ___________________________________________________________

School : ____________________________________________________________



I have declined union representation for a meeting with __________________________

on _________________________________________________________________



_________________________________         _______________________________
Teacher)                                                              (Administrator)


_________________________________         _______________________________
(Date)                                                                  (Date)

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Association of Catholic Teachers • Local 1776
1700 Sansom Street • Suite 903 • Philadelphia, PA 19103
Phone: 215-568-4175 • E-Mail info@act1776.com
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