APPENDIX B
UNION MEMBERSHIP AND UNION DUES OR AGENCY FEES FORM
MEMBERSHIP APPLICATION
please print (last name) (first name) (middle initial) j
}
(street address) (ety) (state) Gp) |
(home phone) (email)
_ a I
(employer) (job title) |
f f |
(work site/department) (hire date) . |
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. I also
agree to abide by all rules, regulations and constitutional provisions established by Local 2322 and
the UAW.
fi
Signature ——
——EE—EEEEE ———
1 (Please sign on line above) (date)
G& PLEASE FILL OUT & SIGN BOTH SECTIONS BEFORE RETURNING
ORIZATION FOR UES
Thereby assign the UAW Local Union 2322 from any wages eamed or to be eamed 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.
T 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 i
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.
Signature __ ee eee ee eens enh eee ee ee
(Please sign on lint above) {date}
Were you ever previously a member of the UAW? No Yes, Ifyes: I was a member |
of UAW Local # while employed at:
Mail card to: UAH Local 2322 ~ 4 Open Square Way, Suite 406 ~ Holyake, MA 01040
(or give to your shap steward or Union Representative) &
