General Membership Card

Request for Union Membership & Representation

YES! I Want a Strong Union for a Strong Contract!

Title

First Name

Middle Initial

Last Name

Street Address or P.O. Box #

Apartment, Suite, etc.

City

State

ZIP/Postal Code

Date of Birth

Local #

Employer

Employee ID

Agency

Job Classification

Work Location

Personal Email

Work Phone

Home 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 at https://www.afscme.org/tcpa.

Registered to vote?

Yes

Authorization

I hereby apply for membership in AFSCME Colorado, Council 76 and its successor or assign (hereafter the “Union”) and I agree to abide by its Constitution and Bylaws. I authorize the Union 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, or upon being covered by an agreement with my Employer, 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, and to 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, and for year to year thereafter unless I give 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 check-off authorization card I signed. Edits to this card, handwritten or otherwise, are not effective.
 
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

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.