AFSCME Council 20 Membership Application

First Name *

Last Name *

Address *

Address 1 *

Address 2

City *

State *

ZIP code *

Home 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 calling the Union at (202) 234-6506.

Personal Email Address *

SSN (Last Four Digits) *

Occupation/Job Title *

Employer *

Worksite *

Department *

Authorization

I hereby apply for membership in Local 3001 of AFSCME Council 20 (hereafter the “Union”) and I agree to abide by its Constitution and Bylaws. By this application, I designate the Union as my duly authorized representative on matters relating to my economic welfare, including wages, hours, working conditions, and the Fair Labor Standards Act (FLSA), and as my representative in any grievances I may have concerning these matters.

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 the Union, and as they may be adjusted periodically by the Union. I further authorize my Employer to remit such amount monthly to the Union.

This voluntary authorization and assignment shall be irrevocable, regardless of whether I am or remain a member of the Union, for a period of one year from the date of execution of this authorization, and for year to year thereafter, unless I give the Employer and the Union written notice of revocation not less than ten (10) days and not more than twenty (20) days before the end of any yearly period. This card supersedes any prior checkoff authorization card I signed.

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, state law may extend favored tax treatment.

Signature

Yes! I want a strong voice at work and in my community. I am interested in supporting my union in the following ways:

Talk to co-workers about the union.

Come to a regional or local meeting.

Participate in a union training to learn more about becoming an activist.

Phone call union members about events & current issues.

Come to a union rally or action.

Meet with legislators and take political action.

AFSCME Virginia

AFSCME Council 20 Membership Application