United Latinos of the UFCW - Official Membership Form (please type or print clearly)
I, an (Active or Retired ) member in good standing of: International Union Region # blanks Local Union # blank
OR (Local # & President’s Name for Local Union Annual Sponsorship): Local
Hereby apply for or renew membership, as indicated above, in the United Latinos of the UFCW. I pledge to abide by the Constitution of the United Latinos of the UFCW, and to cooperate with the National Officer of the United Latinos in implementing the goals and objectives of this organization. I hereby authorize UFCW Local Union No.blanks or UFCW International Union to deduct from my wages, commencing with the next payroll period, the amount as indicated herein. I further request that the International Union and/or UFCW Local No. blank remit said monies to the United Latinos of the UFCW. This authorization shall continue in effect from year to year thereafter or until such time as this authorization is revoked by me in writing. Deductions for all future years will be withheld the first pay period in January. Dues paid under this voluntary check-off are not deductible as charitable contributions for federal tax purposes.
Annual Dues are as follows below:
Return application and monies to:
c/o Rigo Valdez
630 Shatto Pl.
Los Angeles, CA 90005