AFSCME Colorado General Membership Card, AFL-CIO

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

First Name *

Middle Name

Last Name *

Address *

Address 1 *

Address 2

City *

State *

ZIP code *

Personal Email Address *

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 303-355-6504.

Employer *

Employee Number

Occupation/Job Title

Division/Department

Facility/Region

Job Status

Full Time

Part Time

Per Diem

Authorization

I hereby apply for membership in AFSCME Council 18.  (Hereafter the “Union”) and agree to abide by its Constitution and Bylaws. I authorize the union and its successor or assign to act as my exclusive bargaining representative for the purposes of collective bargaining with respect to wages, hours and other terms and conditions of employment 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 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 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 check- off 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

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County Workers Deserve a Voice on the Job. We did it and you can too!

Member Card

AFSCME Colorado General Membership Card, AFL-CIO

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

CO Workers United

Member Card

AFSCME Colorado General Membership Card, AFL-CIO

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