Membership Card – Private Sector

Join our Union! Become an AFSCME member with Dues Authorization

First Name *

Middle Name/Initial

Last Name *

Employer *

Job Title *

Home Address *

Address 1 *

Address 2

City *

State *

ZIP code *

Home Email *

Work Email

Home Phone *

Work Phone

Cell Phone † † By providing my phone number, I understand that AFSCME and its affiliates may use automated calling technologies and/or text message me on my cell phone on a periodic basis. Carrier message and data rates may apply to such texts. You will receive approximately 5 messages each month.

Authorization

I hereby request membership with and authorize Minnesota AFSCME Council 5 to represent me for the purpose of collective bargaining with my employer and to negotiate and conclude all agreements respecting wages, hours and other conditions of employment.  

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.  

Additionally, I hereby request and voluntarily authorize my employer to deduct from my wages an amount equal to the regular monthly dues applicable to members of Minnesota AFSCME Council 5, and further that such amount so deducted be sent to Minnesota AFSCME Council 5 for and on my behalf. This authorization shall remain in effect and shall be irrevocable unless I revoke it by sending written notice to both my employer and Minnesota AFSCME Council 5 during the period not less than sixty (60) and not more than seventy-five (75) days before the annual anniversary date of this authorization. This authorization shall be automatically renewed as an irrevocable check-off year to year unless I revoke it in writing during the above described window period, irrespective of my membership in the Union.  

The invalidity or unenforceability of any particular provision hereof shall not affect the other provisions, and this Agreement shall be construed in all respects as if such invalid or unenforceable provision were omitted. By submitting this form, it shows that I agree with the terms above.

Signature

DIGNITY. OPPORTUNITY. FREEDOM.

FOR ALL.

Membership Card – Private Sector

Join our Union! Become an AFSCME member with Dues Authorization

Minnesota Council 5

Membership Card – Private Sector

Join our Union! Become an AFSCME member with Dues Authorization