ACMEA Dues Authorization

P.O. Box 29527 Oakland, California 94604-9257

ACMEA Dues Authorization

Name *

First Name Last Name Suffix

Your Job Title *

Your Employer *

Your Agency Name *

Your Bargaining Unit *

Home Address *

Street

City *

State *

ZIP Code *

Personal Cell Number *

Area Code Phone Number

Personal Email Address: *

example@example.com

Employee ID *

I, {namePrinted}, authorize the withdrawal dues, assessments, and initiation fees in accordance with the ACMEA Bylaws from my biweekly paycheck. I understand my monthly dues include the following services and benefits:

Full legal representation by the Mastagni Holstedt Law firm.
One-hour free legal advice per matter with Mastagni Holstedt Law firm.
This includes advice in all legal fields such as Civil, Criminal, and Personal Injury.
I will be allowed to attend ACMEA meetings and vote in ACMEA elections.

Eligible members may only join ACMEA during their initial sixty (60) days of eligibility or during open enrollment. The open enrollment begins annually on October 1 and ends on October 31 of each year, to be effective January 1 of the following year.

Employer and Bargaining Unit

Name Printed

Name Printed 2

Date

Month Day Year

Calculation

DateTime

Date Final

File Name

Signature (use your PC mouse or finger to sign)

Signature

Clear

New Dues Card - ACMEA