FORM NLRB-4702 (4-15) National Labor Relations Board Annual Notice for Receipt of Charges and Petitions If your request for annual receipt is for charges or petitions that will only be filed in one Region, submit this form directly to the Regional Director of that Region. Addresses for all Regions can be found at our website; www.nlrb.gov. For charges or petitions that may be filed in more than one Region, you may make a national request by submitting this form to the Division of Operations-Management, Attention Christina Ford at Christina.ford@nlrb.gov. Mark the appropriate box below. To: Regional Director, Region Division of Operations-Management The undersigned hereby requests receipt of all charges and petitions for all matters in which the entity named below is a party and which come before the regional office during the fiscal year, which begins October 1. This Form NLRB-4702 is not a notice of appearance. If the representative named below or any other individual wishes to represent a party in a specific case, Form NLRB-4701, or its equivalent, must be filed with the Regional Director of the Region in which the case is pending. Name of Party: For Fiscal Year (2015, 2016, etc.): REPRESENTATIVE INFORMATION Name of Representative: Mailing Address: E-Mail Address: Office Telephone Number: Cell Phone Number: Fax Number: Signature: Date: American LegalNet, Inc. www.FormsWorkFlow.com