Collective Bargaining Authorization and Membership Card

YES! I want to join our union so we can win respect, better wages and a voice on the job.

First Name

Middle Initial

Last Name

Home Address

Apartment, Suite, etc.

City

State

ZIP/Postal Code

Personal Email

Cell Phone †

† By providing your cell phone number you consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME and its affiliated labor, political and charitable organizations on any subject matter. Your carrier’s rates may apply. You may modify your preferences by emailing [email protected].

Home Phone

Work Phone

Employer

Job Title

Work Site

Hours of Work

Department

Authorization

I, the undersigned, hereby designate the American Federation of State, County and Municipal Employees Council 31, AFL-CIO as my duly chosen and authorized exclusive representative on matters relating to my employment in order to promote and protect my economic welfare.

Upon ratification of our first contract, I hereby assign to the American Federation of State, County and Municipal Employees Council 31 and authorize you to deduct from any salary earned by me an amount equal to dues and assessments, as certified by AFSCME Council 31. I further authorize and request you to remit the amount deducted to AFSCME Council 31 each month.

This authorization shall remain in effect for one year irrespective of whether I am a union member, and be automatically renewed for periods of one year from the date signed below, or until the expiration of the collective bargaining agreement, whichever is sooner. I can revoke this authorization by sending written notice to my employer and to the union no more than 30 days and not less than 10 days before the expiration of the yearly period or before the expiration of the collective bargaining agreement, whichever is sooner. Contributions to AFSCME are not deductible as charitable contributions for income tax purposes.

Signature

My electronic signature is a binding and valid signature. By signing here I agree to all of the terms and conditions set out in this authorization, which apply to my membership, dues payments and, if applicable, PEOPLE payments.