Join AFSCME Local 199

First Name

Middle Initial

Last Name

Street Address

Apartment, Suite, etc.

City

State

ZIP/Postal Code

Date of Birth

Employee ID

Department

Worksite

Personal Email

Home Phone

Work Phone

Cell Phone †

† 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. I may modify my preferences by calling the Union at (305) 805-1075 or emailing the Union at admin@afscmelocal199.com.

Authorization

I hereby apply for membership in AFSCME Local 199 and I agree to abide by its Constitution and Bylaws. By this application, I authorize AFSCME Local 199 and its successor or assign to act as my exclusive bargaining representative for purposes of collective bargaining with respect to wages, hours and other terms and conditions of employment with my Employer.

Effective immediately, I hereby voluntarily authorize and direct my Employer to deduct from my pay each pay period, regardless of whether I am or remain a member of the Union, the amount of dues certified by AFSCME Local 199, and as they may be adjusted periodically by the Union. I further authorize my Employer to remit such amount monthly to AFSCME Local 199. This voluntary authorization and assignment shall be irrevocable, regardless of whether I am or remain a member of the Union, unless I give the Employer and the Union thirty day written notice of revocation. 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.

Payments to the Union are not deductible as charitable donations for federal income tax purposes. However, they may be tax deductible as ordinary and necessary business expenses.

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.