Collective Bargaining Authorization and Membership Card Social share icons You must have JavaScript enabled to use this form. Leave this field blank 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 - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code Employer Department Hours of Work Job Title Work Site Personal Email Home Phone Work Phone 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]. By providing my cell phone number I 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. My carrier’s rates may apply. Authorization I hereby affirm my membership in AFSCME Council 31, AFL-CIO and authorize AFSCME Council 31 (“AFSCME Council 31” or the “Union”) to represent me as my exclusive representative on matters related to my employment. I understand that when a majority of my co-workers join in signing a card, this card can be used to obtain certification of AFSCME Council 31 as our exclusive bargaining representative without an election. I recognize that my authorization of dues deductions, and the continuation of such authorization from one year to the next, is voluntary and not a condition of my employment. Upon ratification of our first contract, I hereby authorize my employer to deduct from my pay each pay period that amount that is equal to dues and to remit such amount monthly to the Union. This voluntary authorization and assignment shall be irrevocable for a period of one year from the date of authorization and shall automatically renew from year to year, irrespective of whether I am or remain a member of the Union, unless I revoke this authorization by sending written notice by the United States Postal Service to the Union postmarked not more than 25 days and not less than 10 days before the expiration of the yearly period described above, or as otherwise provided by law. This card supersedes any prior check-off authorization card I signed. Payments to the Union are not deductible as charitable donations for federal income tax purposes. Signature Reset 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. Sign Your Card