Public Sector Member Card

Welcome to AFSCME Council 65!

Join Your Union! Become an AFSCME 65 Member with Dues Authorization.

First Name

Last Name

Home Address

Apartment, Suite, etc.

City

State

ZIP/Postal Code

Personal Email

Employer

Department

Job Title

Work Hours

Work Site Address

Employee Number

Home Phone

Work Phone

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 218-885-3242 or emailing the Union at info@afscme65.org.

Authorization

I hereby request membership with and authorize AFSCME Council 65 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 with my employer. I agree to abide by its Constitution and Bylaws and those of my Local. Effective immediately, I hereby request and voluntarily authorize my employer to deduct from my wages each pay period, regardless of whether I am or remain a member of the Union, the amount of dues certified by AFSCME Council 65, and as they may be adjusted periodically by AFSCME Council 65, and further that such amount so deducted be sent to AFSCME Council 65 on my behalf.

This voluntary authorization and assignment shall remain in effect and shall be irrevocable, regardless of whether I am or remain a member of AFSCME Council 65, unless I revoke it by sending written notice to both my employer and AFSCME Council 65 during the period not less than thirty (30) and not more than forty-five (45) days before the annual anniversary date of this authorization. This Card supersedes any prior check-off authorization card I signed. While I remain employed in a position represented by AFSCME, 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.

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.

Signature

My electronic signature is a binding and valid signature. By signing here I agree to all of the terms and conditions set out in this authorization, which apply to my membership, dues payments and, if applicable, PEOPLE payments.

Date Signed

Date of Birth