Join the Union! AFT Local Union Name (hereafter referred to as "The Local") Local Number First Name * Last Name * Date of Birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Employee ID Job Title Work Location Contact Information Non-Work Phone * Non-Work Email * Work Phone Home Address Street / P.O. Box City State Zip TO THE BOARD OF TRUSTEES: * I hereby request and voluntarily accept membership in The Local and I agree to abide by its Constitution and Bylaws. I authorize The Local to act as my exclusive representative in collective bargaining over wages, benefits, and other terms and conditions of employment with my employer. AUTHORIZATION FOR DUES WITHHOLDING FROM EARNINGS * I hereby request and voluntarily authorize my employer to deduct from my earnings and pay over to the State Center Federation of Teachers, AFT Local 1533, the regular monthly dues uniformly applicable to members of the Local. This authorization will remain in effect and shall be irrevocable unless I revoke it by sending written notice of to the State Center Federation of Teachers, AFT 1533, within the period of 30 days following the expiration of a written CBA, regardless of whether the Agreement has been extended or superseded. This authorization shall be automatically renewed as an irrevocable check off from year to year unless I revoke it in writing during this window period mentioned herein irrespective of my membership in the Local. Signature * Clear signature Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20212022202320242025 Committee On Political Education Signature * Clear signature SUPPORT THE UNION’S COMMITTEE ON POLITICAL EDUCATION I hereby authorize my employer to deduct from my salary the sum indicated below (contribution choices will appear after you check the authorization box at the front of this text) per pay period and forward that amount to The Local's Committee On Political Action (COPE). This authorization is signed freely and voluntarily and not out of any fear of reprisal, and I will not be favored or disadvantaged because I exercise this right. I understand this money will be used by AFT/COPE to make political contributions. AFT/COPE may engage in joint fundraising efforts with the AFL-CIO. This voluntary authorization may be revoked at any time by notifying The Local's COPE in writing of the desire to do so. Contributions or gifts to AFT/COPE are not deductible as charitable contributions for federal income tax purposes. Authorized COPE Contribution * $10 $15 $25 Other If "Other", Please Specify: * Date of signature * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20212022202320242025 Leave this field blank
