APPENDIX B
UNION MEMBERSHIP AND UNION DUES OR AGENCY FEES FORM
MEMBERSHIP APPLICATION i
please print: (last name) (firstname) (middie initial) i
|
|
- (street address) (city) (state) (zip) |
a)
(home phone) (email)
__ |
(employer) (job title) ¥ |
a: Sipe
(work site/department) (hire date) Deeg”
I hereby accept membership in UAW Local 2322 and authorize UAW Local 2322, its agents or |
Tepresentatives, to act for me as my exclusive representative in collective bargaining on all matters |
pertaining to wages, hours of work, working conditions and other conditions of employment. ITalso
agree to abide by all rules, regulations and constitutional provisions established by Local 2322 and ‘|
the UAW. |
Signature : 2 eg fa wd
ae ——— Saas
(Please sign on line above)
4 PLEASE FILL OUT & SIGN BOTH SECTIONS BEFORE RETURNING |
AUTHORIZAT! IR CHECK-OFF DUES
I hereby assign the UAW Local Union 2322 from any wages earned or to be earned by me such
sums as the Financial Officer of said Local 2322 may certify as due and owing from me as
membership dues, including an initiation fee and monthly dues in such sum as may be established |
from time to time as union dues in accordance with the Constitution of the International Union,
UAW. 1
I authorize and direct you to deduct such amounts from my pay and to remit same to the Union at
such times and in such manner as may be agreed upon between you and the Union any time while
this authorization is in effect.
You WILL NOT pay union dues until your shop’s first contract has been negotiated and
ratified.
This authorization may be revoked by me as of the expiration or anniversary date of the collective |
bargaining agreement covering my employment. To effect such a revocation, written notice, signed
by me, must be received by my Employer and the Union by registered mail not more than sixty
(60) days and not less than fifty (50) days before the contract anniversary/expiration date.
Sig 3 aes ee eae
(Please sign on line above) (date)
Were you ever previously a member of the UAM? No Yes. If yes: I was a member
of UAW Local # while employed at:
Mail card to: UAW Local 2322 ~ 4 Open Square Way, Suite 406 ~ Holyoke, MA 01040
(or give to your shop steward or Union Representative) &
